Widening or narrowing income inequalities in myocardial infarction? Time trends in life years free of myocardial infarction and after incidence

Abstract

Background Despite substantial improvements in prevention and therapy, myocardial infarction (MI) remains a frequent health event, causing high mortality and serious health impairments. Previous research lacks evidence on how social inequalities in incidence and mortality risks developed over time, and on how these developments affect the lifespan free of MI and after MI in different social subgroups. This study investigates income inequalities in MI-free life years and life years after MI and whether these inequalities widened or narrowed over time. Methods The analyses are based on claims data of a large German health insurance provider insuring approximately 2.8 million individuals in the federal state Lower Saxony. Trends in income inequalities in incidence and mortality were assessed for all subjects aged 60 years and older by comparing the time periods 2006–2008 and 2015–2017 using multistate survival models. Trends in the number of life years free of MI and after MI were calculated separately for income groups by applying multistate life table analyses. Results MI incidence and mortality risks decreased over time, but declines were strongest among men and women in the higher-income group. While life years free of MI increased in men and women with higher incomes, no MI-free life years were gained in the low-income group. Among men, life years after MI increased irrespective of income group. Conclusions Income inequalities in the lifespan spent free of MI and after MI widened over time. In particular, men with low incomes are disadvantaged, as life years spent after MI increased, but no life years free of MI were gained.

Effect of socioeconomic status on the occurrence and in-hospital outcome among patients with acute myocardial infarction: an observational analytic case-control study

“…Additionally, the rise in population case-fatality rates with age could be attributed to diminished effectiveness of life-saving treatments, reduced hospitalization rates, less frequent utilization of diagnostic and therapeutic procedures, prolonged delays from the onset of symptoms to admission to the emergency room, and increased comorbidity among the elderly (39). On the contrary, high socioeconomic relative risks could be related and limited to premature MI events (40,41).…”

Development and validation of dynamic models to predict postdischarge mortality risk in patients with acute myocardial infarction: results from China Acute Myocardial Infarction Registry

“…Besides, the hospital level was shown to provide no additional prognostic information beyond current predictors in the risk prediction models. Socioeconomic factors, which were known as risk factors for survival following myocardial infarction,26–29 were not included in the present models because we sought to develop models based on predictors directly reflecting patients’ clinical conditions. Notably, socioeconomic factors were also not included in existing risk prediction tools 6 7 9 16.…”

Länger gesund im Beruf? Trends in den Lebensjahren frei von Herz-Kreislauf- und Muskel-Skelett-Erkrankungen in GKV-Daten für die Erwerbstätigen- und Allgemeinbevölkerung

“…Die Studie fokussiert auf 2 für die Erwerbsfähigkeit hochrelevante Erkrankungsgruppen, deren Inzidenz sich in der Bevölkerung über die Zeit konträr entwickelt hat. Während bei Herz-Kreislauf-Erkrankungen ein Rückgang der Morbidität und Mortalität berichtet wird [ 16 , 17 , 33 – 35 ], steigt die Zahl der AU-Tage und die Zahl der Diagnosen und Medikamentenverordnungen bei Muskel-Skelett-Erkrankungen an [ 1 , 20 , 36 ]. Diese Entwicklungen haben einen deutlichen Einfluss auf die erkrankungsfreien Lebensjahre in der Allgemein- und der Erwerbstätigenbevölkerung.…”

“…Während bereits zahlreiche Studien die Entwicklung der Lebenszeit frei von Behinderungen und funktionalen Einschränkungen [ 9 – 11 ] oder einer schlechten subjektiven Gesundheit [ 12 , 13 ] untersuchten, bleibt weiterhin unklar, welche Erkrankungen sich dahinter verbergen. Studien zur Entwicklung der Lebenszeit frei von spezifischen Erkrankungen sind bisher selten [ 14 – 17 ].…”