Prognosis of acute coronary events is worse in patients living alone: the FINAMI myocardial infarction register.
BACKGROUND
Single living has been associated with a worse prognosis of acute coronary syndrome (ACS). We aimed to study the relation of sociodemographic characteristics to the morbidity, mortality, and case fatality (CF) of ACS in a large population-based ACS register.


METHODS
The population-based FINAMI myocardial infarction register recorded 15,330 cases of ACS among persons aged 35-99 years in Finland in 1993-2002. Record linkage with the files of Statistics Finland provided information on sociodemographic characteristics (marital status, household size).


RESULTS
ACS incidence and 28-day mortality rate were higher in unmarried men and women in all age groups. The prehospital CF of incident ACS was higher in single living and/or unmarried 35-64-year-old people. The 28-day CF was 26% (95% confidence interval, CI, 24-29%) in married men, 42% (95% CI 37-47%) in men who had previously been married, and 51% (95% CI 46-57%) in never-married men. Among women, the corresponding figures were 20% (95% CI 15-24%), 32% (95% CI 25-39%), and 43% (95% CI 31-56%). Most of these CF differences were apparent already at the prehospital phase. The only difference in treatment was that middle-aged men living alone or unmarried received thrombolysis less often. The disparities in ACS morbidity and mortality by marital status tended to widen during the study period.


CONCLUSIONS
Single living and/or being unmarried increases the risk of having a heart attack and worsens its prognosis both in men and women regardless of age. Most of the excess mortality appears already before the hospital admission and seems not to be related to differences in treatment of ACS.
Turku University Hospital, Turku, Finland aklamm@utu.fi.
Aino
A
Lammintausta
Turku University Hospital, Turku, Finland.
Juhani K E
JK
Airaksinen
Turku University Hospital, Turku, Finland.
Pirjo
P
Immonen-Räihä
National Institute for Health and Welfare, Helsinki, Finland.
Jorma
J
Torppa
Oulu University Hospital, Oulu, Finland.
Antero Y
AY
Kesäniemi
North Karelia Central Hospital, Joensuu, Finland.
Matti
M
Ketonen
University of Eastern Finland, Kuopio, Finland Kuopio University Hospital, Kuopio, Finland.
Heli
H
Koukkunen
Oulu University Hospital, Oulu, Finland.
Päivi
P
Kärjä-Koskenkari
Kuopio University Hospital, Kuopio, Finland.
Seppo
S
Lehto
National Institute for Health and Welfare, Helsinki, Finland.
Veikko
V
Salomaa
D054058:Acute Coronary Syndrome / Q000401:mortality*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D012307:Risk Factors; D012847:Single Person
Epidemiology; living arrangements; marital status; mortality; myocardial infarction