title: Dimensions of socioeconomic status and clinical outcome after primary percutaneous coronary intervention.
abstract: BACKGROUND
  The association between low socioeconomic status (SES) and high mortality from coronary heart disease is well-known. However, the role of SES in relation to the clinical outcome after primary percutaneous coronary intervention remains poorly understood.
  
  
  RESULTS
  We studied 7385 patients treated with primary percutaneous coronary intervention. Participants were divided into high-SES and low-SES groups according to income, education, and employment status. The primary outcome was major adverse cardiac events (cardiac death, recurrent myocardial infarction, and target vessel revascularization) at maximum follow-up (mean, 3.7 years). Low-SES patients had more adverse baseline risk profiles than high-SES patients. The cumulative risk of major adverse cardiac events after maximum follow-up was higher among low-income patients and unemployed patients compared with their counterparts (income: hazard ratio, 1.68; 95% CI, 1.47-1.92; employment status: hazard ratio, 1.75; 95% CI, 1.46-2.10). After adjustment for patient characteristics, these differences were substantially attenuated (income: hazard ratio, 1.12; 95% CI, 0.93-1.33; employment status: hazard ratio, 1.27; 95% CI, 1.03-1.56). Further adjustment for admission findings, procedure-related data, and medical treatment during follow-up did not significantly affect the associations. With education as the SES indicator, no between-group differences were observed in the risk of the composite end point.
  
  
  CONCLUSIONS
  Even in a tax-financed healthcare system, low-SES patients treated with primary percutaneous coronary intervention face a worse prognosis than high-SES patients. The poor outcome seems to be largely explained by differences in baseline patient characteristics. Employment status and income (but not education level) were associated with clinical outcomes.
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Jakobsen
authors.forename: Troels
authors.initials: T
authors.lastname: Niemann
authors.forename: Niels
authors.initials: N
authors.lastname: Thorsgaard
authors.forename: Leif
authors.initials: L
authors.lastname: Thuesen
authors.forename: Jens F
authors.initials: JF
authors.lastname: Lassen
authors.forename: Lisette O
authors.initials: LO
authors.lastname: Jensen
authors.forename: Per
authors.initials: P
authors.lastname: Thayssen
authors.forename: Jan
authors.initials: J
authors.lastname: Ravkilde
authors.forename: Hans H
authors.initials: HH
authors.lastname: Tilsted
authors.forename: Frank
authors.initials: F
authors.lastname: Mehnert
authors.forename: Søren P
authors.initials: SP
authors.lastname: Johnsen
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003718:Denmark; D004522:Educational Status; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D013222:State Medicine; D013997:Time Factors; D016896:Treatment Outcome