Socioeconomic environment and survival in patients after ST-segment elevation myocardial infarction (STEMI): a longitudinal study for the City of Vienna

Autor(en)

Sonja Spitzer, Vanessa di Lego, Kuhn Michael, Rudolf Berger, Christian Roth

Abstrakt

Design: Hospital-based observational data of STEMI patients are linked with district-level information on SEE and the mortality register, enabling survival analyses with a 19-year follow-up (2000-2018).

Setting: The analysis is set at the main tertiary care hospital of the City of Vienna. On weekends, it is the only hospital in charge of treating STEMIs and thus provides representative data for the Viennese population.

Participants: The study comprises a total of 1481 patients with STEMI, including women and men aged 24-94 years.

Primary and secondary outcome measures: Primary outcome measures are age at STEMI and age at death. We further distinguish between deaths from coronary artery disease (CAD), deaths from acute coronary syndrome (ACS), and other causes of death. SEE is proxied via mean individual gross income from employment in each municipal district.

Results: Results are based on Kaplan-Meier survival probability estimates, Cox proportional hazard regressions and competing risk models, always using age as the time scale. Descriptive findings suggest a socioeconomic gradient in the age at death after STEMI. This finding is, however, not supported by the regression results. Female patients with STEMI have better survival outcomes, but only for deaths related to CAD (HR: 0.668, 95% CIs 0.452 to 0.985) and other causes of deaths (HR: 0.627, 95% CIs 0.444 to 0.884), and not for deaths from the more acute ACS.

Conclusions: Additional research is necessary to further disentangle the interaction between SEE and age at STEMI, as our findings suggest that individuals from poorer districts have STEMI at younger ages, which indicates vulnerability in regard to health conditions in these neighbourhoods.

Organisation(en)

Institut für Demografie

Externe Organisation(en)

Österreichische Akademie der Wissenschaften (ÖAW), Wittgenstein Centre for Demography and Global Human Capital, Medizinische Universität Wien, Krankenhaus der Barmherzigen Brüder Eisenstadt

Journal

BMJ Open

Band

12

Seiten

1-11

Anzahl der Seiten

11

ISSN

2044-6055

DOI

https://doi.org/10.1136/bmjopen-2021-058698

Publikationsdatum

07-2022

Peer-reviewed

Ja

ÖFOS 2012

504006 Demographie, 502021 Mikroökonomie, 303010 Gesundheitsökonomie

Schlagwörter

ASJC Scopus Sachgebiete

Allgemeine Medizin

Link zum Portal

https://ucrisportal.univie.ac.at/de/publications/b46e7d74-b0d2-4aab-8c0f-e8a71b0dced0