Effects of socioeconomic status on mortality after acute myocardial infarction.
OBJECTIVE
To assess the effects of socioeconomic status on mortality in patients with acute myocardial infarction.


METHODS
We studied a retrospective cohort of 5622 patients who presented to a hospital emergency department with an initial episode of acute myocardial infarction between April 1998 and March 2002 in the Province of Alberta, Canada. Our main outcome measure was 1-year all-cause mortality following the index emergency department visit; we used socioeconomic status (measured by neighborhood median household income) as our main predictor after controlling for patient and hospital characteristics and revascularization.


RESULTS
Socioeconomic status profoundly affected the rate of emergency department presentation and the process and outcome of acute myocardial infarction care. In patients belonging to the lowest versus the highest socioeconomic status quartile, the risk of presenting to the emergency department was 72% higher (P <.001); at 1 year, revascularization was lower (36% vs 48%, P <.001), and mortality higher (19.1% vs 9.1%, P <.001). Socioeconomic status was independently associated with 1-year mortality after adjustment for baseline characteristics and 1-year revascularization, and socioeconomic status was especially influential in non-revascularized patients.


CONCLUSIONS
Given the influence of socioeconomic status on mortality after acute myocardial infarction and the key role of revascularization in modulating this relationship, our study has important implications for access to and process of cardiac care.
Chang
Wei-Ching
WC
University of Alberta, Edmonton, Alberta, Canada.
Kaul
Padma
P
Westerhout
Cynthia M
CM
Graham
Michelle M
MM
Armstrong
Paul W
PW
D000368:Aged; D000416:Alberta / Q000453:epidemiology; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012923:Social Class; D012959:Socioeconomic Factors