Socioeconomic environment and survival in patients after ST-segment elevation myocardial infarction (STEMI): a longitudinal study for the City of Vienna
Objectives This study investigates the relationship between socioeconomic environment (SEE) and survival after ST-segment elevation myocardial infarction (STEMI) separately for women and men in the City of Vienna, Austria.Design Hospital-based observational data of STEMI patients are linked with dis...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2022-07-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/7/e058698.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832576442009911296 |
|---|---|
| author | Christian Roth Michael Kühn Rudolf Berger Sonja Spitzer Vanessa di Lego |
| author_facet | Christian Roth Michael Kühn Rudolf Berger Sonja Spitzer Vanessa di Lego |
| author_sort | Christian Roth |
| collection | DOAJ |
| description | Objectives This study investigates the relationship between socioeconomic environment (SEE) and survival after ST-segment elevation myocardial infarction (STEMI) separately for women and men in the City of Vienna, Austria.Design Hospital-based observational data of STEMI patients are linked with district-level information on SEE and the mortality register, enabling survival analyses with a 19-year follow-up (2000–2018).Setting The analysis is set at the main tertiary care hospital of the City of Vienna. On weekends, it is the only hospital in charge of treating STEMIs and thus provides representative data for the Viennese population.Participants The study comprises a total of 1481 patients with STEMI, including women and men aged 24–94 years.Primary and secondary outcome measures Primary outcome measures are age at STEMI and age at death. We further distinguish between deaths from coronary artery disease (CAD), deaths from acute coronary syndrome (ACS), and other causes of death. SEE is proxied via mean individual gross income from employment in each municipal district.Results Results are based on Kaplan-Meier survival probability estimates, Cox proportional hazard regressions and competing risk models, always using age as the time scale. Descriptive findings suggest a socioeconomic gradient in the age at death after STEMI. This finding is, however, not supported by the regression results. Female patients with STEMI have better survival outcomes, but only for deaths related to CAD (HR: 0.668, 95% CIs 0.452 to 0.985) and other causes of deaths (HR: 0.627, 95% CIs 0.444 to 0.884), and not for deaths from the more acute ACS.Conclusions Additional research is necessary to further disentangle the interaction between SEE and age at STEMI, as our findings suggest that individuals from poorer districts have STEMI at younger ages, which indicates vulnerability in regard to health conditions in these neighbourhoods. |
| format | Article |
| id | doaj-art-d9b4507d340748bb9b02aa859ff0ff67 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-d9b4507d340748bb9b02aa859ff0ff672025-01-31T05:40:15ZengBMJ Publishing GroupBMJ Open2044-60552022-07-0112710.1136/bmjopen-2021-058698Socioeconomic environment and survival in patients after ST-segment elevation myocardial infarction (STEMI): a longitudinal study for the City of ViennaChristian Roth0Michael Kühn1Rudolf Berger2Sonja Spitzer3Vanessa di Lego4Department of Internal Medicine II, Cardiology, Medical University of Vienna, Wien, AustriaVienna Institute of Demography, Austrian Academy of Sciences, Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), Wien, AustriaDepartment of Internal Medicine II, Cardiology, Medical University of Vienna, Wien, AustriaDepartment of Demography, University of Vienna, Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), Vienna, AustriaVienna Institute of Demography, Austrian Academy of Sciences, Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), Wien, AustriaObjectives This study investigates the relationship between socioeconomic environment (SEE) and survival after ST-segment elevation myocardial infarction (STEMI) separately for women and men in the City of Vienna, Austria.Design Hospital-based observational data of STEMI patients are linked with district-level information on SEE and the mortality register, enabling survival analyses with a 19-year follow-up (2000–2018).Setting The analysis is set at the main tertiary care hospital of the City of Vienna. On weekends, it is the only hospital in charge of treating STEMIs and thus provides representative data for the Viennese population.Participants The study comprises a total of 1481 patients with STEMI, including women and men aged 24–94 years.Primary and secondary outcome measures Primary outcome measures are age at STEMI and age at death. We further distinguish between deaths from coronary artery disease (CAD), deaths from acute coronary syndrome (ACS), and other causes of death. SEE is proxied via mean individual gross income from employment in each municipal district.Results Results are based on Kaplan-Meier survival probability estimates, Cox proportional hazard regressions and competing risk models, always using age as the time scale. Descriptive findings suggest a socioeconomic gradient in the age at death after STEMI. This finding is, however, not supported by the regression results. Female patients with STEMI have better survival outcomes, but only for deaths related to CAD (HR: 0.668, 95% CIs 0.452 to 0.985) and other causes of deaths (HR: 0.627, 95% CIs 0.444 to 0.884), and not for deaths from the more acute ACS.Conclusions Additional research is necessary to further disentangle the interaction between SEE and age at STEMI, as our findings suggest that individuals from poorer districts have STEMI at younger ages, which indicates vulnerability in regard to health conditions in these neighbourhoods.https://bmjopen.bmj.com/content/12/7/e058698.full |
| spellingShingle | Christian Roth Michael Kühn Rudolf Berger Sonja Spitzer Vanessa di Lego Socioeconomic environment and survival in patients after ST-segment elevation myocardial infarction (STEMI): a longitudinal study for the City of Vienna BMJ Open |
| title | Socioeconomic environment and survival in patients after ST-segment elevation myocardial infarction (STEMI): a longitudinal study for the City of Vienna |
| title_full | Socioeconomic environment and survival in patients after ST-segment elevation myocardial infarction (STEMI): a longitudinal study for the City of Vienna |
| title_fullStr | Socioeconomic environment and survival in patients after ST-segment elevation myocardial infarction (STEMI): a longitudinal study for the City of Vienna |
| title_full_unstemmed | Socioeconomic environment and survival in patients after ST-segment elevation myocardial infarction (STEMI): a longitudinal study for the City of Vienna |
| title_short | Socioeconomic environment and survival in patients after ST-segment elevation myocardial infarction (STEMI): a longitudinal study for the City of Vienna |
| title_sort | socioeconomic environment and survival in patients after st segment elevation myocardial infarction stemi a longitudinal study for the city of vienna |
| url | https://bmjopen.bmj.com/content/12/7/e058698.full |
| work_keys_str_mv | AT christianroth socioeconomicenvironmentandsurvivalinpatientsafterstsegmentelevationmyocardialinfarctionstemialongitudinalstudyforthecityofvienna AT michaelkuhn socioeconomicenvironmentandsurvivalinpatientsafterstsegmentelevationmyocardialinfarctionstemialongitudinalstudyforthecityofvienna AT rudolfberger socioeconomicenvironmentandsurvivalinpatientsafterstsegmentelevationmyocardialinfarctionstemialongitudinalstudyforthecityofvienna AT sonjaspitzer socioeconomicenvironmentandsurvivalinpatientsafterstsegmentelevationmyocardialinfarctionstemialongitudinalstudyforthecityofvienna AT vanessadilego socioeconomicenvironmentandsurvivalinpatientsafterstsegmentelevationmyocardialinfarctionstemialongitudinalstudyforthecityofvienna |