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Bermon A, Licht-Ardila M, Manrique-Hernández F, Hurtado-Ortiz A, Cañon D, Molina Castaño CF. Factors Associated With Mortality During the First Year Post Infarction: Survival Analysis of Patients With Acute Myocardial Infarction in Colombia. Cureus 2024; 16:e58118. [PMID: 38738138 PMCID: PMC11088855 DOI: 10.7759/cureus.58118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/14/2024] Open
Abstract
INTRODUCTION Cardiovascular diseases account for over 80% of global deaths. Risk factors and social determinants influence mortality in patients post acute myocardial infarction (AMI). OBJECTIVE To evaluate factors associated with post-AMI mortality during the one-year follow-up. MATERIALS AND METHODS The study is a prospective cohort study of adults aged 18 years and older with type 1 AMI conducted between October 2021 and January 2024. Intrahospital and outpatient information was collected. Statistical analyses included the Kaplan-Meier survival curve and Cox regression analysis. Proportional hazards and model predictive capacity were evaluated. RESULTS A total of 1873 patients were included, with a 9.4% mortality rate in the first year. At one year, the estimated survival probability was 88.61% (95% CI: 86.82-90.18). Cox analysis identified several factors associated with mortality, highlighting age (HR = 1.04, 95% CI: 1.02-1.06, p = 0.001), diabetes (HR = 1.77, 95% CI: 1.09-2.87, p = 0.020), renal insufficiency (HR = 2.25, 95% CI: 1.32-3.84, p = 0.003), and type of intervention. The model evaluation showed strong predictive capacity. CONCLUSIONS It is essential to emphasize the importance of comprehensive management in AMI patients with risk factors such as diabetes and chronic kidney disease, as they are significant predictors of mortality during the first year post infarction.
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Affiliation(s)
- Anderson Bermon
- Epidemiology, Escuela de Graduados, Universidad CES, Medellin, COL
| | | | | | | | - Diana Cañon
- Cardiology, Fundación Cardiovascular de Colombia, Piedecuesta, COL
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Rokkedrejer SI, Schlünssen V, Kinnerup MB, Vestergaard JM, Kolstad HA, Cramer C. Risk of myocardial infarction among pigeon breeders: A follow-up study. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2024; 78:507-511. [PMID: 38240700 DOI: 10.1080/19338244.2024.2302113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/01/2024] [Indexed: 02/08/2024]
Abstract
Pigeon breeders are exposed to high levels of fine particulate organic matter in the pigeon lofts. A total of 6,704 pigeon breeders and their 1:30 sex and age-matched referents from the general Danish population were followed from 1980 or first year of membership in the Danish Racing Pigeon Association, until first event of myocardial infarction, emigration, death, or end of study, on December 31, 2013. Information on outcomes and covariates was obtained by record linkage with national registers. Stratified Cox regression models estimated the hazard ratio of myocardial infarction, adjusted for occupation and residence at the start of follow-up. Compared with referents, pigeon breeders had an adjusted hazard ratio of 1.14 (95% CI: 1.05-1.22) for myocardial infarction. Exposure to pigeon-derived organic dust may increase the risk of myocardial infarction, but this finding needs to be corroborated.
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Affiliation(s)
- Sandra Ileby Rokkedrejer
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Vivi Schlünssen
- Department of Public Health, Unit for Work, Environment and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Martin Byskov Kinnerup
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Medom Vestergaard
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Albert Kolstad
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Christine Cramer
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Unit for Work, Environment and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
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Weight N, Moledina S, Volgman AS, Bagur R, Wijeysundera HC, Sun LY, Chadi Alraies M, Rashid M, Kontopantelis E, Mamas MA. Socioeconomic disparities in the management and outcomes of acute myocardial infarction. Heart 2023; 110:122-131. [PMID: 37558395 DOI: 10.1136/heartjnl-2023-322601] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/21/2023] [Indexed: 08/11/2023] Open
Abstract
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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Affiliation(s)
- Nicholas Weight
- Keele Cardiovascular Research Group, Keele University Faculty of Medicine & Health Sciences, Keele, UK
| | - Saadiq Moledina
- Keele Cardiovascular Research Group, Keele University Faculty of Medicine & Health Sciences, Keele, UK
| | | | - Rodrigo Bagur
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | | | - Louise Y Sun
- Division of Cardiac Anesthesiology, Stanford University School of Medicine, Stanford, California, USA
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - M Chadi Alraies
- Cardiovascular Institute, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Keele University Faculty of Medicine & Health Sciences, Keele, UK
| | - Evangelos Kontopantelis
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, Greater Manchester, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University Faculty of Medicine & Health Sciences, Keele, UK
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Frederiksen TC, Dahm CC, Preis SR, Lin H, Trinquart L, Benjamin EJ, Kornej J. The bidirectional association between atrial fibrillation and myocardial infarction. Nat Rev Cardiol 2023; 20:631-644. [PMID: 37069297 DOI: 10.1038/s41569-023-00857-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 04/19/2023]
Abstract
Atrial fibrillation (AF) is associated with an increased risk of myocardial infarction (MI) and vice versa. This bidirectional association relies on shared risk factors as well as on several direct and indirect mechanisms, including inflammation, atrial ischaemia, left ventricular remodelling, myocardial oxygen supply-demand mismatch and coronary artery embolism, through which one condition can predispose to the other. Patients with both AF and MI are at greater risk of stroke, heart failure and death than patients with only one of the conditions. In this Review, we describe the bidirectional association between AF and MI. We discuss the pathogenic basis of this bidirectional relationship, describe the risk of adverse outcomes when the two conditions coexist, and review current data and guidelines on the prevention and management of both conditions. We also identify important gaps in the literature and propose directions for future research on the bidirectional association between AF and MI. The Review also features a summary of methodological approaches for the study of bidirectional associations in population-based studies.
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Affiliation(s)
- Tanja Charlotte Frederiksen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Sarah R Preis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Honghuang Lin
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Ludovic Trinquart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA
| | - Emelia J Benjamin
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
| | - Jelena Kornej
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
- Framingham Heart Study, Framingham, MA, USA.
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Wang T, Li Y, Zheng X. Association of socioeconomic status with cardiovascular disease and cardiovascular risk factors: a systematic review and meta-analysis. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2023:1-15. [PMID: 36714072 PMCID: PMC9867543 DOI: 10.1007/s10389-023-01825-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/08/2023] [Indexed: 01/22/2023]
Abstract
Aim Cardiovascular disease (CVD) remains one of the leading causes of mortality worldwide, and several studies have indicated the association between socioeconomic status (SES) with CVD and cardiovascular risk factors (CVRFs). It is necessary to elucidate the association of SES and CVRFs with CVD. Subject and methods We searched PubMed, Embase, Web of Science, and the Cochrane Library for publications, using "socioeconomic status," "cardiovascular disease," and corresponding synonyms to obtain literature. The quality of studies was evaluated using the National Institutes of Health Quality Assessment Tool (NIH-QAT). All analyses were performed using Stata V.12.0. Results There were 31 eligible studies included in this meta-analysis. All studies presented a low risk of bias via NIH-QAT assessment. As for CVD incidence/mortality, pooled hazard ratios (HR) of low and middle vs. high income were [HR = 1.22 (1.17-1.28); HR = 1.12 (1.09-1.16)] and [HR = 1.37 (1.21-1.56); HR = 1.19 (1.06-1.34)]. The HR of education were [HR = 1.44 (1.28-1.63); HR = 1.2 (1.11-1.3)] and [HR = 1.5 (1.22-1.83); HR = 1.13 (1.05-1.22)]. The HR of deprivation were [HR = 1.28 (1.16-1.41); HR = 1.07 (1.03-1.11)] and [HR = 1.19 (1.11-1.29); HR = 1.1 (1.02-1.17)]. SES was negatively correlated with CVD outcomes. A subgroup analysis of gender and national income level also yielded a negative correlation, and additional details were also obtained. Conclusions SES is inversely correlated with CVD outcomes and the prevalence of CVRFs. As for CVD incidence, women may be more sensitive to income and education. In terms of CVD mortality, men may be more sensitive to income and education, and people from low- and middle-income countries are sensitive to income and education. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-023-01825-4.
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Affiliation(s)
- Tao Wang
- School of Economics and Management, Southwest Petroleum University, NO. 8 Xindu Avenue, Xindu District, Chengdu City, Sichuan Province China
| | - Yilin Li
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaoqiang Zheng
- School of Economics and Management, Southwest Petroleum University, NO. 8 Xindu Avenue, Xindu District, Chengdu City, Sichuan Province China
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Socioeconomic inequity in incidence, outcomes and care for acute coronary syndrome: A systematic review. Int J Cardiol 2022; 356:19-29. [DOI: 10.1016/j.ijcard.2022.03.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/17/2022] [Accepted: 03/24/2022] [Indexed: 12/17/2022]
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Tetzlaff J, Tetzlaff F, Geyer S, Sperlich S, Epping J. Widening or narrowing income inequalities in myocardial infarction? Time trends in life years free of myocardial infarction and after incidence. Popul Health Metr 2021; 19:47. [PMID: 34952590 PMCID: PMC8709953 DOI: 10.1186/s12963-021-00280-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/10/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Despite substantial improvements in prevention and therapy, myocardial infarction (MI) remains a frequent health event, causing high mortality and serious health impairments. Previous research lacks evidence on how social inequalities in incidence and mortality risks developed over time, and on how these developments affect the lifespan free of MI and after MI in different social subgroups. This study investigates income inequalities in MI-free life years and life years after MI and whether these inequalities widened or narrowed over time. METHODS The analyses are based on claims data of a large German health insurance provider insuring approximately 2.8 million individuals in the federal state Lower Saxony. Trends in income inequalities in incidence and mortality were assessed for all subjects aged 60 years and older by comparing the time periods 2006-2008 and 2015-2017 using multistate survival models. Trends in the number of life years free of MI and after MI were calculated separately for income groups by applying multistate life table analyses. RESULTS MI incidence and mortality risks decreased over time, but declines were strongest among men and women in the higher-income group. While life years free of MI increased in men and women with higher incomes, no MI-free life years were gained in the low-income group. Among men, life years after MI increased irrespective of income group. CONCLUSIONS Income inequalities in the lifespan spent free of MI and after MI widened over time. In particular, men with low incomes are disadvantaged, as life years spent after MI increased, but no life years free of MI were gained.
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Affiliation(s)
- Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany.
| | - Fabian Tetzlaff
- Institute for General Practice, Hannover Medical School, Hanover, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | | | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
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Measuring the Effect of Place, Socioeconomic Status, and Racism on Coronary Heart Disease: Recent Trends and Missed Opportunities. CURR EPIDEMIOL REP 2021. [DOI: 10.1007/s40471-021-00281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Tetzlaff J, Geyer S, Westhoff-Bleck M, Sperlich S, Epping J, Tetzlaff F. Social inequalities in mild and severe myocardial infarction: how large is the gap in health expectancies? BMC Public Health 2021; 21:259. [PMID: 33526035 PMCID: PMC7852180 DOI: 10.1186/s12889-021-10236-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/13/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Acute myocardial infarction (MI) remains a frequent health event and a major contributor to long-term impairments globally. So far, research on social inequalities in MI incidence and mortality with respect to MI severity is limited. Furthermore, evidence is lacking on disparities in the length of life affected by MI. This study investigates social inequalities in MI incidence and mortality as well as in life years free of MI and affected by the consequences of mild or severe MI. METHODS The study is based on data of a large German statutory health insurance provider covering the years 2008 to 2017 (N = 1,253,083). Income inequalities in MI incidence and mortality risks and in life years with mild or severe MI and without MI were analysed using multistate analyses. The assessment of MI severity is based on diagnosed heart failure causing physical limitations. RESULTS During the study period a total of 39,832 mild MI, 22,844 severe MI, 276,582 deaths without MI, 15,120 deaths after mild MI and 16,495 deaths after severe MI occurred. Clear inequalities were found in MI incidence and mortality, which were strongest among men and in severe MI incidence. Moreover, substantial inequalities were found in life years free of MI in both genders to the disadvantage of those with low incomes and increased life years after mild MI in men with higher incomes. Life years after severe MI were similar across income groups. CONCLUSIONS Social inequalities in MI incidence and mortality risks led to clear disparities in the length of life free of MI with men with low incomes being most disadvantaged. Our findings stress the importance of primary and secondary prevention focusing especially on socially disadvantaged groups.
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Affiliation(s)
- Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany.
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | | | | | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | - Fabian Tetzlaff
- Institute for General Practice, Hannover Medical School, Hanover, Germany
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Spatial distribution of in- and out-of-hospital mortality one year after acute myocardial infarction in France. Am J Prev Cardiol 2020; 2:100037. [PMID: 34327460 PMCID: PMC8315588 DOI: 10.1016/j.ajpc.2020.100037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/21/2022] Open
Abstract
Objective To describe the spatial distribution of acute myocardial infarction (AMI) mortality in France in association with the socio-economic characteristics of the patient's place of residence. Methods In this population-based study, we included patients hospitalized for AMI identified according to ICD-10 codes, using data from the national health insurance database from January 1, 2013 to December 31, 2014. In- and out-of-hospital deaths were identified over a period of 1 year following the first hospital stay for AMI.An exploratory analysis was performed to classify area profiles. The spatial analysis of AMI mortality was performed using a principal component analysis followed by an ascending hierarchical classification taking into account socio-economic data, access-time by road to coronary angiography, standardized in-hospital prevalence, and 1 year mortality. Results Over the 2 years, 115,418 patients were hospitalized with a diagnosis of AMI. Patients were a mean of 68 ± 15 years and most were men (68.5%). The overall mortality rate was 12.2% after 1 year. More than half of patients (65.5%) underwent an early revascularization procedure. The map of standardized 1 year mortality showed a geographic area of high mortality extending diagonally from north-east to south-west France. We identified 6 different area profiles with standardized mortality varying from 15.9 to 54.4 per 100,000 inhabitants. The spatial distribution of higher mortality was associated with lower socioeconomic levels. These findings were not associated with a lower access to coronary angiography. Conclusion There are considerable geographical differences in the prevalence of AMI and 1 year mortality. The spatial distribution of lower healthcare indicators follows the distribution of social inequalities. This study highlights the importance of focusing national policies on universally accessible prevention programs such as the promotion cardiac rehabilitation and healthy lifestyles.
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Luy M, Zannella M, Wegner-Siegmundt C, Minagawa Y, Lutz W, Caselli G. The impact of increasing education levels on rising life expectancy: a decomposition analysis for Italy, Denmark, and the USA. GENUS 2019. [DOI: 10.1186/s41118-019-0055-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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12
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Torssander J, Moustgaard H, Peltonen R, Kilpi F, Martikainen P. Partner resources and incidence and survival in two major causes of death. SSM Popul Health 2018; 4:271-279. [PMID: 29854911 PMCID: PMC5976827 DOI: 10.1016/j.ssmph.2018.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/10/2017] [Accepted: 03/04/2018] [Indexed: 11/30/2022] Open
Abstract
Because people tend to marry social equals - and possibly also because partners affect each other's health - the social position of one partner is associated with the other partner's health and mortality. Although this link is fairly well established, the underlying mechanisms are not fully identified. Analyzing disease incidence and survival separately may help us to assess when in the course of the disease a partner's resources are of most significance. This article addresses the importance of partner's education, income, employment status, and health for incidence and survival in two major causes of death: cancer and cardiovascular diseases (CVD). Based on a sample of Finnish middle-aged and older couples (around 200,000 individuals) we show that a partner's education is more often connected to incidence than to survival, in particular for CVD. Once ill, any direct effect of partner's education seems to decline: The survival chances after being hospitalized for cancer or CVD are rather associated with partner's employment status and/or income level when other individual and partner factors are adjusted for. In addition, a partner's history of poor health predicted higher CVD incidence and, for women, lower cancer survival. The findings suggest that various partner's characteristics may have different implications for disease and survival, respectively. A wider focus on social determinants of health at the household level, including partner's social resources, is needed.
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Affiliation(s)
- Jenny Torssander
- Swedish Institute for Social Research, Stockholm University, Sweden
| | - Heta Moustgaard
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland
| | - Riina Peltonen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland
| | - Fanny Kilpi
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland.,CHESS, University of Stockholm, Stockholm, Sweden.,Max Planck Institute of Demographic Research, Rostock, Germany
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13
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Aarnio E, Martikainen J, Winn AN, Huupponen R, Vahtera J, Korhonen MJ. Socioeconomic Inequalities in Statin Adherence Under Universal Coverage: Does Sex Matter? Circ Cardiovasc Qual Outcomes 2016; 9:704-713. [PMID: 27756795 DOI: 10.1161/circoutcomes.116.002728] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 08/31/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Previous research shows that low socioeconomic position (SEP; especially low income) is associated with statin nonadherence. We investigated the relationship between SEP and statin adherence in a country with universal coverage using group-based trajectory modeling in addition to the proportion of days covered. METHODS AND RESULTS Using data from Finnish healthcare registers, we identified 116 846 individuals, aged 45 to 75 years, who initiated statin therapy for primary prevention of cardiovascular disease. We measured adherence as proportion of days covered over an 18-month period since initiation and identified different adherence patterns based on monthly adherence with group-based trajectory modeling. When adjusted for age, marital status, residential area, clinical characteristics, and copayment, low SEP was associated with statin nonadherence (proportion of days covered <80%) among men (eg, lowest versus highest income quintile: odds ratio, 1.41; 95% confidence interval, 1.32-1.50; basic versus higher-degree education: odds ratio, 1.18; 95% confidence interval, 1.13-1.24; unemployment versus employment: odds ratio, 1.17; 95% confidence interval, 1.10-1.25). Among women, the corresponding associations were different (P<0.001 for sex-by-income quintile, sex-by-education level, and sex-by-labor market status interactions) and mainly nonsignificant. Results based on adherence trajectories showed that men in low SEP were likely to belong to trajectories presenting a fast decline in adherence. CONCLUSIONS Low SEP was associated with overall and rapidly increasing statin nonadherence among men. Conversely, in women, associations between SEP and nonadherence were weak and inconsistent. Group-based trajectory modeling provided insight into the dynamics of statin adherence and its association with SEP.
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Affiliation(s)
- Emma Aarnio
- From the Department of Clinical Pharmacology, Tykslab, Turku University Hospital, Finland (E.A., R.H.); School of Pharmacy, University of Eastern Finland, Kuopio, Finland (E.A., J.M.); Department of Health Policy and Management, School of Public Health (A.N.W.) and Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy (M.J.K.), University of North Carolina at Chapel Hill; Department of Pharmacology, Drug Development and Therapeutics (R.H., M.J.K.) and Department of Public Health (J.V., M.J.K.), University of Turku, Finland; and Turku University Hospital, Finland (J.V.).
| | - Janne Martikainen
- From the Department of Clinical Pharmacology, Tykslab, Turku University Hospital, Finland (E.A., R.H.); School of Pharmacy, University of Eastern Finland, Kuopio, Finland (E.A., J.M.); Department of Health Policy and Management, School of Public Health (A.N.W.) and Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy (M.J.K.), University of North Carolina at Chapel Hill; Department of Pharmacology, Drug Development and Therapeutics (R.H., M.J.K.) and Department of Public Health (J.V., M.J.K.), University of Turku, Finland; and Turku University Hospital, Finland (J.V.)
| | - Aaron N Winn
- From the Department of Clinical Pharmacology, Tykslab, Turku University Hospital, Finland (E.A., R.H.); School of Pharmacy, University of Eastern Finland, Kuopio, Finland (E.A., J.M.); Department of Health Policy and Management, School of Public Health (A.N.W.) and Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy (M.J.K.), University of North Carolina at Chapel Hill; Department of Pharmacology, Drug Development and Therapeutics (R.H., M.J.K.) and Department of Public Health (J.V., M.J.K.), University of Turku, Finland; and Turku University Hospital, Finland (J.V.)
| | - Risto Huupponen
- From the Department of Clinical Pharmacology, Tykslab, Turku University Hospital, Finland (E.A., R.H.); School of Pharmacy, University of Eastern Finland, Kuopio, Finland (E.A., J.M.); Department of Health Policy and Management, School of Public Health (A.N.W.) and Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy (M.J.K.), University of North Carolina at Chapel Hill; Department of Pharmacology, Drug Development and Therapeutics (R.H., M.J.K.) and Department of Public Health (J.V., M.J.K.), University of Turku, Finland; and Turku University Hospital, Finland (J.V.)
| | - Jussi Vahtera
- From the Department of Clinical Pharmacology, Tykslab, Turku University Hospital, Finland (E.A., R.H.); School of Pharmacy, University of Eastern Finland, Kuopio, Finland (E.A., J.M.); Department of Health Policy and Management, School of Public Health (A.N.W.) and Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy (M.J.K.), University of North Carolina at Chapel Hill; Department of Pharmacology, Drug Development and Therapeutics (R.H., M.J.K.) and Department of Public Health (J.V., M.J.K.), University of Turku, Finland; and Turku University Hospital, Finland (J.V.)
| | - Maarit J Korhonen
- From the Department of Clinical Pharmacology, Tykslab, Turku University Hospital, Finland (E.A., R.H.); School of Pharmacy, University of Eastern Finland, Kuopio, Finland (E.A., J.M.); Department of Health Policy and Management, School of Public Health (A.N.W.) and Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy (M.J.K.), University of North Carolina at Chapel Hill; Department of Pharmacology, Drug Development and Therapeutics (R.H., M.J.K.) and Department of Public Health (J.V., M.J.K.), University of Turku, Finland; and Turku University Hospital, Finland (J.V.)
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