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Socioeconomic disparities in the management and outcomes of acute myocardial infarction.
Weight, Nicholas; Moledina, Saadiq; Volgman, Annabelle Santos; Bagur, Rodrigo; Wijeysundera, Harindra C; Sun, Louise Y; Chadi Alraies, M; Rashid, Muhammad; Kontopantelis, Evangelos; Mamas, Mamas A.
Afiliação
  • Weight N; Keele Cardiovascular Research Group, Keele University Faculty of Medicine & Health Sciences, Keele, UK.
  • Moledina S; Keele Cardiovascular Research Group, Keele University Faculty of Medicine & Health Sciences, Keele, UK.
  • Volgman AS; Division of Cardiology, Rush University, Chicago, Illinois, USA.
  • Bagur R; London Health Sciences Centre, Western University, London, Ontario, Canada.
  • Wijeysundera HC; Schulich Heart Program, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.
  • Sun LY; Division of Cardiac Anesthesiology, Stanford University School of Medicine, Stanford, California, USA.
  • Chadi Alraies M; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
  • Rashid M; Cardiovascular Institute, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA.
  • Kontopantelis E; Keele Cardiovascular Research Group, Keele University Faculty of Medicine & Health Sciences, Keele, UK.
  • Mamas MA; Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, Greater Manchester, UK.
Heart ; 110(2): 122-131, 2023 Dec 20.
Article em En | MEDLINE | ID: mdl-37558395
BACKGROUND: Patients from lower socioeconomic status areas have poorer outcomes following acute myocardial infarction (AMI); however, how ethnicity modifies such socioeconomic disparities is unclear. METHODS: Using the UK Myocardial Ischaemia National Audit Project (MINAP) registry, we divided 370 064 patients with AMI into quintiles based on Index of Multiple Deprivation (IMD) score, comprising seven domains including income, health, employment and education. We compared white and 'ethnic-minority' patients, comprising Black, Asian and mixed ethnicity patients (as recorded in MINAP); further analyses compared the constituents of the ethnic-minority group. Logistic regression models examined the role of the IMD, ethnicity and their interaction on the odds of in-hospital mortality. RESULTS: More patients from the most deprived quintile (Q5) were from ethnic-minority backgrounds (Q5; 15% vs Q1; 4%). In-hospital mortality (OR 1.10, 95% CI 1.01 to 1.19, p=0.025) and major adverse cardiovascular event (MACE) (OR 1.07, 95% CI 1.00 to 1.15, p=0.048) were more likely in Q5, and MACE was more likely in ethnic-minority patients (OR 1.40, 95% CI 1.00 to 1.95, p=0.048) versus white (OR 1.05, 95% CI 0.98 to 1.13, p=0.027) in Q5. In subgroup analyses, Black patients had the highest in-hospital mortality within the most affluent quintile (Q1) (Black: 0.079, 95% CI 0.046 to 0.112, p<0.001; White: 0.062, 95% CI 0.059 to 0.066, p<0.001), but not in Q5 (Black: 0.065, 95% CI 0.054 to 0.077, p<0.001; White: 0.065, 95% CI 0.061 to 0.069, p<0.001). CONCLUSION: Patients with a higher deprivation score were more often from an ethnic-minority background, more likely to suffer in-hospital mortality or MACE when compared with the most affluent quintile, and this relationship was stronger in ethnic minorities compared with White patients.
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Texto completo: 1 Coleções: 01-internacional Contexto em Saúde: 1_ASSA2030 / 2_ODS3 Base de dados: MEDLINE Assunto principal: Etnicidade / Mortalidade Hospitalar / Disparidades Socioeconômicas em Saúde / Grupos Minoritários / Infarto do Miocárdio Tipo de estudo: Prognostic_studies Aspecto: Determinantes_sociais_saude / Equity_inequality Limite: Humans Idioma: En Revista: Heart Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Contexto em Saúde: 1_ASSA2030 / 2_ODS3 Base de dados: MEDLINE Assunto principal: Etnicidade / Mortalidade Hospitalar / Disparidades Socioeconômicas em Saúde / Grupos Minoritários / Infarto do Miocárdio Tipo de estudo: Prognostic_studies Aspecto: Determinantes_sociais_saude / Equity_inequality Limite: Humans Idioma: En Revista: Heart Ano de publicação: 2023 Tipo de documento: Article