The role of the socio-economic environment on medical outcomes after ST-segment elevation myocardial infarction

Abstract

Background: According to the World Health Organization, coronary artery disease (CAD), including ST-segment elevation myocardial infarction (STEMI), is the most common cause of death worldwide as well as in Europe and Austria. There is valid data on the impact of conventional risk factors on the medical outcomes for STEMI patients. However, only few studies examine the role of the socio-economic environment for medical outcomes. The main task of this study is to investigate if the socio-economic environment of patients who underwent percutaneous coronary intervention (PCI) after STEMI has an impact on the distribution of risk factors and medical outcomes. Methods: The study focuses on the population of the City of Vienna, Austria, and includes 870 STEMI patients, who underwent PCI at the General Hospital of Vienna (AKH Wien) between 2008 and 2012. The following data were collected: conventional risk factors (hypertension, hyperlipidemia, diabetes, overweight, smoking, family history and vascular disease) and socio-economic indicators of the patient's residential district (number of residents, income pre-tax, residents per general practitioner, residents per internal specialist, compulsory education only, academic degree and rate of unemployment). Cox regressions were performed to evaluate the impact of socio-economic environment and conventional risk factors on survival. Results: Most of the conventional risk factors show a significant difference between deceased and surviving patients. The study revealed significant differences across districts in relation to the socio-economic background of STEMI patients. Surprisingly, medical outcomes, as measured by the survival of patients, are significantly related to a patient's district of residence (p-Value = 0.028) but not in a systematic way as far as the socio-economic environment of these districts is concerned. Conclusions: The study provides intuitive evidence for a hitherto understudied Central European context on the link between socio-economic environment and conventional risk factors at population level and the link between conventional risk factors and survival both at the population at the individual level. While this is in line with previous evidence and suggestive of the incorporation of measures of socio-economic status (SES) into policy & guidelines toward the management of CAD, more data on the SES - STEMI nexus are needed at individual level.