title: Socioeconomic Status and in-hospital Mortality of Acute Coronary Syndrome: Can Education and Occupation Serve as Preventive Measures?
abstract: BACKGROUND
  Socioeconomic status (SES) can greatly affect the clinical outcome of medical problems. We sought to assess the in-hospital mortality of patients with the acute coronary syndrome (ACS) according to their SES.
  
  
  METHODS
  All patients admitted to Tehran Heart Center due to 1(st)-time ACS between March 2004 and August 2011 were assessed. The patients who were illiterate/lowly educated (≤5 years attained education) and were unemployed were considered low-SES patients and those who were employed and had high educational levels (>5 years attained education) were regarded as high-SES patients. Demographic, clinical, paraclinical, and in-hospital medical progress data were recorded. Death during the course of hospitalization was considered the end point, and the impact of SES on in-hospital mortality was evaluated.
  
  
  RESULTS
  A total of 6246 hospitalized patients (3290 low SES and 2956 high SES) were included (mean age = 60.3 ± 12.1 years, male = 2772 [44.4%]). Among them, 79 (1.26%) patients died. Univariable analysis showed a significantly higher mortality rate in the low-SES group (1.9% vs. 0.6%; P < 0.001). After adjustment for possible cofounders, SES still showed a significant effect on the in-hospital mortality of the ACS patients in that the high-SES patients had a lower in-hospital mortality rate (odds ratio: 0.304, 95% confidence interval: 0.094-0.980; P = 0.046).
  
  
  CONCLUSIONS
  This study found that patients with low SES were at a higher risk of in-hospital mortality due to the ACS. Furthermore, the results suggest the need for increased availability of jobs as well as improved levels of education as preventive measures to curb the unfolding deaths owing to coronary artery syndrome.
authors.affiliation: Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden ; Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran ; Department of Heart, Family Health Research Center, Iranian Petroleum Health Research Institute, Tehran, Iran.
authors.forename: Seyed Hesameddin
authors.initials: SH
authors.lastname: Abbasi
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden ; Department o de Epidemiologia, Instituto de Medicina Social, Universidade do Estado de Rio de Janeiro, Brazil.
authors.forename: Antonio Ponce
authors.initials: AP
authors.lastname: De Leon
authors.affiliation: Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Seyed Ebrahim
authors.initials: SE
authors.lastname: Kassaian
authors.affiliation: Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Abbasali
authors.initials: A
authors.lastname: Karimi
authors.affiliation: Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Örjan
authors.initials: Ö
authors.lastname: Sundin
authors.affiliation: Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Arash
authors.initials: A
authors.lastname: Jalali
authors.affiliation: Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden ; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Soares
authors.affiliation: Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden ; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden ; Department of Occupational and Public Health Sciences University of Gävle, Gävle, Sweden.
authors.forename: Gloria
authors.initials: G
authors.lastname: Macassa
keywords: Coronary disease; education; mortality; occupation