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Inequalities after STEMI in NHS services: is there really a postcode lottery?
Session:
Painel 5 - E-Cardiologia e Saúde Publica 1
Speaker:
Cátia Santos Ferreira
Congress:
CPC 2020
Topic:
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
Theme:
34. Public Health and Health Economics
Subtheme:
34.1 Public Health
Session Type:
Posters
FP Number:
---
Authors:
Cátia Santos Ferreira; Rui Baptista; Ana Isabel Ribeiro; João André Ferreira; André Azul Freitas; José Almeida; Sofia S. Martinho; James Milner; Valdirene Gonçalves; Pedro Monteiro; Sílvia Monteiro; Francisco Gonçalves; Lino Gonçalves
Abstract
<p>INTRODUCTION: Failure to address the impact of social determinants of health attenuates efficacy of proven prevention recommendations, namely because important considerations related to socioeconomic disadvantage are not captured by existing cardiovascular disease (CDV) risk stratification methods. We aimed to assess how socioeconomic determinants influence recurrent MI and all-cause death after myocardial infarction (MI) in Portugal.</p> <p>METHODS: We conducted a retrospective, observational cohort study, including all patients with a ST-elevation MI (STEMI) admitted to and discharged alive from an intensive cardiac care unit between 2004 and 2017 (n=1809). The median (interquartile range) follow-up was 6 (4-9) years. We used survival models to assess the relationship between their municipal (i) income by purchasing power <em>per capita</em> (PPC), (ii) access to health care and (iii) illiteracy and recurrent MI and all-cause mortality. To assess residential socioeconomic deprivation, each individual’s residential postcode was merged with the recently validated Portuguese version of European Deprivation Index (EDI). The index was categorized into quintiles (Q1-least deprived to Q5-most deprived).</p> <p>RESULTS: The mean age was 64±14 years; 74% were male. Regarding individual socioeconomic variables, PPC and medical appointments in primary health centers per inhabitant were predictors of all-cause mortality (Log-rank <em>P</em>=0.042 and 0.047, respectively), but not recurrent MI; however, in multivariate analysis adjusted for sex, age and ejection fraction, this association was no longer significant (HR 1.00; 95%CI 0.99-1.00, <em>P</em>=0.49 and HR 1.00; 95%CI 0.89-1.17, <em>P</em>=0.77, respectively). Additionally, no evident association between illiteracy and all-cause mortality or MI was present (Figure 1). Concerning EDI, demographic data was similar among the quintiles (Table 1). Although EDI quintiles were not associated with all-cause mortality (Log-rank <em>P</em>=0.69), the EDI was an independent predictor of recurrent MI (Figure 2). On multivariate analysis, adjusted for age, sex, hypertension, diabetes and LDL cholesterol, the HR for the most deprived (Q5) to the least deprived (Q1) quintile was 1.91 (95%CI 1.05-3.49, <em>P</em>=0.035) for MI. </p> <p>CONCLUSIONS: Our study shows that differential cardiovascular outcomes persist by important socioeconomic characteristics in patients after STEMI. Failure to address the impact of social determinants of health reduces the efficacy of proven secondary prevention recommendations.</p>
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