title: Low socioeconomic status of a patient's residential area is associated with worse prognosis after acute myocardial infarction in Sweden.
abstract: BACKGROUND
  Previous studies have established a relationship between socioeconomic status (SES) and survival in coronary heart disease. Acute cardiac care in Sweden is considered to be excellent and independent of SES. We studied the influence of area-level socioeconomic status on mortality after hospitalization for acute myocardial infarction (AMI) between 1995 and 2013 in the Gothenburg metropolitan area, which has little over 800,000 inhabitants and includes three city hospitals.
  
  
  METHODS
  Data were obtained from the SWEDEHEART registry (Swedish Websystem for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) and the Swedish Central Bureau of Statistics for patients hospitalized for ST-elevation myocardial infarction (STEMI) and non-STEMI in the city of Gothenburg in Western Sweden. The groups were compared using Cox proportional hazards regression and logistic regression.
  
  
  RESULTS
  10,895 (36% female) patients were hospitalized due to AMI during the study period. Patients residing in areas with lower SES had higher rates of smoking and diabetes (P<0.001), and were also at increased risk of developing complications, including heart failure and cardiogenic shock (P<0.05). Living in an area with lower SES associated with increased risk of dying after an AMI also in models adjusted for risk factors (P<0.05).
  
  
  CONCLUSIONS
  Also in a country with strong egalitarian traditions, lower SES associates with worse prognosis after AMI, an association that persists after adjustments for differences in traditional cardiovascular risk factors.
authors.affiliation: Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden.
authors.forename: Göran
authors.initials: G
authors.lastname: Bergström
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Redfors
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Oskar
authors.initials: O
authors.lastname: Angerås
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Christian
authors.initials: C
authors.lastname: Dworeck
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Yangzhen
authors.initials: Y
authors.lastname: Shao
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Inger
authors.initials: I
authors.lastname: Haraldsson
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Petur
authors.initials: P
authors.lastname: Petursson
authors.affiliation: Department of Cardiology, University Hospital Centre, Zagreb, Croatia.
authors.forename: Davor
authors.initials: D
authors.lastname: Milicic
authors.affiliation: Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Wedel
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Albertsson
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Truls
authors.initials: T
authors.lastname: Råmunddal
authors.affiliation: Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Rosengren
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden. Electronic address: elmir@wlab.gu.se.
authors.forename: Elmir
authors.initials: E
authors.lastname: Omerovic
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D054625:Healthcare Disparities; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000191:economics* / Q000401:mortality*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012959:Socioeconomic Factors; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology
keywords: Inequalities in health; Mortality; Myocardial infarction; Socioeconomic status