title: Myocardial infarction in singapore: ethnic variation in evidence-based therapy and its association with socioeconomic status, social network size and perceived stress level.
abstract: BACKGROUND
  Singapore is a multiethnic Asian country comprising predominantly Chinese, Malays, and Indians. We sought to study the disparities in evidence-based therapy for people from these three ethnic groups who were admitted to hospital with ST-segment elevation myocardial infarction (STEMI). We also examined its association with socioeconomic level and social network size and the influence on psychological stress level.
  
  
  METHODS
  In a prospective study, patients admitted with STEMI were recruited for a questionnaire survey. Relevant demographic and clinical data were collected.
  
  
  RESULTS
  A total of 364 patients were recruited and categorised based on ethnicity: Chinese (222 patients), Malays (72 patients), and Indians (70 patients). Malays and Indians were significantly younger than Chinese at the time of presentation with STEMI. Malays had significantly more children than the Chinese and Indians. Malays were in the lowest socioeconomic class, based on education level (P ≤ .02) and residential type (P ≤ .003). Most (87%) patients were treated with primary percutaneous coronary intervention. There were no significant differences between Chinese, Malays, and Indians in accessibility to primary percutaneous coronary intervention, symptom-to-balloon time, door-to-balloon time, and prescription of evidence-based medications. Malays had larger social networks for information support (P ≤ .05) and financial support (P ≤ .04) than Chinese and Indians. There were no significant differences between the three ethnic groups in satisfaction with social support. The perceived stress level was higher among Malays and Indians than Chinese.
  
  
  CONCLUSIONS
  Although Malays were underprivileged in the socioeconomic level, no significant difference in healthcare disparities were observed among the three ethnic groups. This may be a reflection of the advancement in Singapore's healthcare system. The lower socioeconomic level may also explain the higher perceived stress level in Malays.
authors.affiliation: Cardiac Department, National University Heart Centre, Singapore. Electronic address: thihannyinyi@gmail.com.
authors.forename: Thet
authors.initials: T
authors.lastname: Hein
authors.forename: Germaine
authors.initials: G
authors.lastname: Loo
authors.forename: Bee-Choo
authors.initials: BC
authors.lastname: Tai
authors.forename: Qian-Hui
authors.initials: QH
authors.lastname: Phua
authors.forename: Mark Y
authors.initials: MY
authors.lastname: Chan
authors.forename: Kian-Keong
authors.initials: KK
authors.lastname: Poh
authors.forename: Boon-Lock
authors.initials: BL
authors.lastname: Chia
authors.forename: Mark
authors.initials: M
authors.lastname: Richards
authors.forename: Chi-Hang
authors.initials: CH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000208:ethnology / Q000523:psychology / Q000628:therapy; D011446:Prospective Studies; D012846:Singapore / Q000453:epidemiology / Q000208:ethnology; D012944:Social Support; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology / Q000208:ethnology / Q000523:psychology / Q000628:therapy
keywords: Asia; Heart disease; Social support; Stress; Treatment