Socioeconomic differentials in recurrent ischaemia and mortality after acute myocardial infarction

Barakat, Khalid; Stevenson, S.R.; Wilkinson, Paul; Suliman, A; Ranjadayalan, Kulasegaram; Timmis, Adam

doi:10.1136/heart.85.4.390

Cited by 51 publications

(48 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[2][3][4] By contrast, very little inequality was apparent in small cohorts from the United Kingdom, Italy, and France. 5,29,30 The disparity highlights the health benefits of universal healthcare.…”

Section: Socioeconomic Inequalitymentioning

confidence: 99%

The UK National Health Service

Hawkins

Scholes

Bajekal

et al. 2013

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

Background— Social gradients in cardiovascular mortality across the United Kingdom may reflect differences in incidence, disease severity, or treatment. It is unknown whether a universal healthcare system delivers equitable lifesaving medical therapy for coronary heart disease. We therefore examined secular trends in the use of key medical therapies stratified by socioeconomic circumstances across a broad spectrum of coronary disease presentations, including acute coronary syndromes, secondary prevention, and clinical angina. Methods and Results— This was a cross-sectional observational analysis of nationally representative primary and secondary care data from the United Kingdom. Data on treatments for all myocardial infarction patients in 2003 and 2007 were derived from the Myocardial Ischemia National Audit Project (n=51 755). Data on treatments for patients with chronic angina (n=33 211) or requiring secondary prevention (n=32 976) in 1999 and 2007 were extracted from the General Practice Research Database. Socioeconomic circumstances were defined using a weighted composite of 7 area-level deprivation domains. Treatment estimates were age-standardized. Use of all therapies increased in all patient groups, both men and women. Improvements were most marked in primary care, where use of β-blockers, statins, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for secondary prevention and treatment of angina doubled, from ≈30% to >60%. Small age gradients persisted for some therapies. No consistent socioeconomic gradients or sex differences were observed for myocardial infarction and postrevascularization (hard diagnoses). However, some sex inequality was apparent in the treatment of younger women with angina. Conclusions— Cardiovascular treatment is generally equitable and independent of socioeconomic circumstances. Future strategies should aim to further increase overall treatment levels and to eradicate remaining age and sex inequalities.

show abstract

Section: Socioeconomic Inequalitymentioning

confidence: 99%

The UK National Health Service

Hawkins

Scholes

Bajekal

et al. 2013

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

show abstract

“…[6][7][8] However, a recent Canadian study found no significant association between SES and mortality up to one year after hospitalisation. 9 In Europe, fatality rates in the first month were significantly higher among less privileged patients in Finland 3 and England, 10 but not Scotland 1 ; increased mortality in the first year was associated with low SES in Finland, 3 but not England. 10 Results on inequities in non-invasive treatments for cardiovascular disease are inconsistent.…”

mentioning

confidence: 95%

“…9 In Europe, fatality rates in the first month were significantly higher among less privileged patients in Finland 3 and England, 10 but not Scotland 1 ; increased mortality in the first year was associated with low SES in Finland, 3 but not England. 10 Results on inequities in non-invasive treatments for cardiovascular disease are inconsistent. [9][10][11][12] In many locations, underprivileged groups are less likely to receive invasive and diagnostic procedures and more likely to experience delays in these types of care.…”

mentioning

confidence: 95%

Associations of area based deprivation status and individual educational attainment with incidence, treatment, and prognosis of first coronary event in Rome, Italy

Picciotto

Forastiére²,

Stafoggia³

et al. 2006

Journal of Epidemiology & Community Health

View full text Add to dashboard Cite

Background: Socioeconomic gradients in the occurrence of myocardial infarction are well known, but few studies have examined socioeconomic disparities in post-infarction outcomes. The objective of this study was to explore relations of socioeconomic status with the incidence, treatment, and outcome of first coronary event in Rome, Italy, during the period 1998-2000, examining effect modification by gender. Methods: Subjects were Rome residents aged 35-84 years who died from first acute coronary event before reaching the hospital (n = 3470) or were hospitalised for first acute myocardial infarction (n = 8467). Area based deprivation status and patients' educational attainment were the exposure variables. The outcomes were: incidence of coronary event; recanalisation at the index hospitalisation and fatality within 28 days of hospitalisation; cardiac readmissions and fatality between 28 days and one year of index hospitalisation. Results: Incidence rates increased as area based deprivation status increased; the effect was stronger among women than among men (men RR = 1.40, 95%CI:1.30, 1.50, women RR = 1.78, 95%CI:1.60, 1.98, most compared with least deprived). Rates of recanalisation were significantly lower in the most deprived patients than in the least deprived (OR = 0.77, 95%CI:0.59, 0.99) and in the less educated than in the highly educated (OR = 0.73, 95%CI:0.58, 0.90). Associations of short term fatality with area based deprivation status and educational attainment were weak and inconsistent. However, neither deprivation status nor education was associated with one year outcomes. Conclusions: Area based deprivation status is strongly related to incidence of coronary events, and more so among women than among men. Deprivation status and educational attainment are weakly and inconsistently associated with short term fatality but seem not to influence one year prognosis of acute myocardial infarction. Deprived and less educated patients experience limited access to recanalisation procedures.

show abstract

“…[1][2][3][4] For example, compared to other patients, socially disadvantaged patients have a higher incidence of cardiovascular disease [4][5][6][7] and a poorer prognosis once cardiovascular disease has become clinically apparent. [8][9][10][11] Social scientists use the term socioeconomic gradients for associations between disease and socioeconomic status. In explaining these gradients, it is important to identify the contributions of risk factors for disease and to distinguish them from the contributions of poor access to health services, both preventive and therapeutic.…”

mentioning

confidence: 99%

Lesson From Canada’s Universal Care: Socially Disadvantaged Patients Use More Health Services, Still Have Poorer Health

et al. 2011

View full text Add to dashboard Cite

Lower socioeconomic status is commonly related to worse health. If poor access to health care were the only explanation, universal access to care should eliminate the association. We studied 14,800 patients with access to Canada's universal health care system who were initially free of cardiac disease, tracking them for at least ten years and seven months. We found that socially disadvantaged patients used health care services more than did their counterparts with higher incomes and education. We also found that service use by people with lower incomes and less education had little impact on their poorer health outcomes, particularly mortality. Countries contemplating national health insurance cannot rely on universal health care to eliminate historical disparities in outcomes suffered by disadvantaged groups. Universal access can only reduce these disparities. Our findings suggest the need to introduce largescale preventive strategies early in patients' lives to help change unhealthy behavior.

show abstract

Socioeconomic differentials in recurrent ischaemia and mortality after acute myocardial infarction

Cited by 51 publications

References 19 publications

The UK National Health Service

The UK National Health Service

Associations of area based deprivation status and individual educational attainment with incidence, treatment, and prognosis of first coronary event in Rome, Italy

Lesson From Canada’s Universal Care: Socially Disadvantaged Patients Use More Health Services, Still Have Poorer Health

Contact Info

Product

Resources

About