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Socioeconomic status, functional recovery, and long-term mortality among patients surviving acute myocardial infarction.
- Source :
-
PloS one [PLoS One] 2013 Jun 03; Vol. 8 (6), pp. e65130. Date of Electronic Publication: 2013 Jun 03 (Print Publication: 2014). - Publication Year :
- 2013
-
Abstract
- Objectives: To examine the relationship between socio-economic status (SES), functional recovery and long-term mortality following acute myocardial infarction (AMI).<br />Background: The extent to which SES mortality disparities are explained by differences in functional recovery following AMI is unclear.<br />Methods: We prospectively examined 1368 patients who survived at least one-year following an index AMI between 1999 and 2003 in Ontario, Canada. Each patient was linked to administrative data and followed over 9.6 years to track mortality. All patients underwent medical chart abstraction and telephone interviews following AMI to identify individual-level SES, clinical factors, processes of care (i.e., use of, and adherence, to evidence-based medications, physician visits, invasive cardiac procedures, referrals to cardiac rehabilitation), as well as changes in psychosocial stressors, quality of life, and self-reported functional capacity.<br />Results: As compared with their lower SES counterparts, higher SES patients experienced greater functional recovery (1.80 ml/kg/min average increase in peak V02, P<0.001) after adjusting for all baseline clinical factors. Post-AMI functional recovery was the strongest modifiable predictor of long-term mortality (Adjusted HR for each ml/kg/min increase in functional capacity: 0.91; 95% CI: 0.87-0.94, P<0.001) irrespective of SES (P = 0.51 for interaction between SES, functional recovery, and mortality). SES-mortality associations were attenuated by 27% after adjustments for functional recovery, rendering the residual SES-mortality association no longer statistically significant (Adjusted HR: 0.84; 95% CI:0.70-1.00, P = 0.05). The effects of functional recovery on SES-mortality associations were not explained by access inequities to physician specialists or cardiac rehabilitation.<br />Conclusions: Functional recovery may play an important role in explaining SES-mortality gradients following AMI.
- Subjects :
- Aged
Delivery of Health Care economics
Delivery of Health Care statistics & numerical data
Depression etiology
Female
Humans
Male
Middle Aged
Myocardial Infarction complications
Myocardial Infarction economics
Ontario epidemiology
Secondary Prevention
Stress, Psychological economics
Stress, Psychological epidemiology
Stress, Psychological etiology
Survival Analysis
Time Factors
Income statistics & numerical data
Myocardial Infarction mortality
Myocardial Infarction physiopathology
Recovery of Function
Subjects
Details
- Language :
- English
- ISSN :
- 1932-6203
- Volume :
- 8
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- PloS one
- Publication Type :
- Academic Journal
- Accession number :
- 23755180
- Full Text :
- https://doi.org/10.1371/journal.pone.0065130