TY - JOUR
T1 - Socioeconomic deprivation and prognostic outcomes in acute coronary syndrome
T2 - A meta-analysis using multidimensional socioeconomic status indices
AU - Anand, Vickram Vijay
AU - Zhe, Ethan Lee Cheng
AU - Chin, Yip Han
AU - Goh, Rachel Sze Jen
AU - Lin, Chaoxing
AU - Kueh, Martin Tze Wah
AU - Chong, Bryan
AU - Kong, Gwyneth
AU - Tay, Phoebe Wen Lin
AU - Dalakoti, Mayank
AU - Muthiah, Mark
AU - Dimitriadis, Georgios K.
AU - Wang, Jiong Wei
AU - Mehta, Anurag
AU - Foo, Roger
AU - Tse, Gary
AU - Figtree, Gemma A.
AU - Loh, Poay Huan
AU - Chan, Mark Y.
AU - Mamas, Mamas A.
AU - Chew, Nicholas W.S.
N1 - Publisher Copyright:
© 2023 Elsevier B.V.
PY - 2023/7/15
Y1 - 2023/7/15
N2 - Background: Low socioeconomic status (SES) is an important prognosticator amongst patients with acute coronary syndrome (ACS). This paper analysed the effects of SES on ACS outcomes. Methods: Medline and Embase were searched for articles reporting outcomes of ACS patients stratified by SES using a multidimensional index, comprising at least 2 of the following components: Income, Education and Employment. A comparative meta-analysis was conducted using random-effects models to estimate the risk ratio of all-cause mortality in low SES vs high SES populations, stratified according to geographical region, study year, follow-up duration and SES index. Results: A total of 29 studies comprising of 301,340 individuals were included, of whom 43.7% were classified as low SES. While patients of both SES groups had similar cardiovascular risk profiles, ACS patients of low SES had significantly higher risk of all-cause mortality (adjusted HR:1.19, 95%CI: 1.10–1.1.29, p < 0.001) compared to patients of high SES, with higher 1-year mortality (RR:1.08, 95%CI:1.03–1.13, p = 0.0057) but not 30-day mortality (RR:1.07, 95%CI:0.98–1.16, p = 0.1003). Despite having similar rates of ST-elevation myocardial infarction and non-ST-elevation ACS, individuals with low SES had lower rates of coronary revascularisation (RR:0.95, 95%CI:0.91–0.99, p = 0.0115) and had higher cerebrovascular accident risk (RR:1.25, 95%CI:1.01–1.55, p = 0.0469). Excess mortality risk was independent of region (p = 0.2636), study year (p = 0.7271) and duration of follow-up (p = 0.0604) but was dependent on the SES index used (p < 0.0001). Conclusion: Low SES is associated with increased mortality post-ACS, with suboptimal coronary revascularisation rates compared to those of high SES. Concerted efforts are needed to address the global ACS-related socioeconomic inequity. Registration and protocol: The current study was registered with PROSPERO, ID: CRD42022347987.
AB - Background: Low socioeconomic status (SES) is an important prognosticator amongst patients with acute coronary syndrome (ACS). This paper analysed the effects of SES on ACS outcomes. Methods: Medline and Embase were searched for articles reporting outcomes of ACS patients stratified by SES using a multidimensional index, comprising at least 2 of the following components: Income, Education and Employment. A comparative meta-analysis was conducted using random-effects models to estimate the risk ratio of all-cause mortality in low SES vs high SES populations, stratified according to geographical region, study year, follow-up duration and SES index. Results: A total of 29 studies comprising of 301,340 individuals were included, of whom 43.7% were classified as low SES. While patients of both SES groups had similar cardiovascular risk profiles, ACS patients of low SES had significantly higher risk of all-cause mortality (adjusted HR:1.19, 95%CI: 1.10–1.1.29, p < 0.001) compared to patients of high SES, with higher 1-year mortality (RR:1.08, 95%CI:1.03–1.13, p = 0.0057) but not 30-day mortality (RR:1.07, 95%CI:0.98–1.16, p = 0.1003). Despite having similar rates of ST-elevation myocardial infarction and non-ST-elevation ACS, individuals with low SES had lower rates of coronary revascularisation (RR:0.95, 95%CI:0.91–0.99, p = 0.0115) and had higher cerebrovascular accident risk (RR:1.25, 95%CI:1.01–1.55, p = 0.0469). Excess mortality risk was independent of region (p = 0.2636), study year (p = 0.7271) and duration of follow-up (p = 0.0604) but was dependent on the SES index used (p < 0.0001). Conclusion: Low SES is associated with increased mortality post-ACS, with suboptimal coronary revascularisation rates compared to those of high SES. Concerted efforts are needed to address the global ACS-related socioeconomic inequity. Registration and protocol: The current study was registered with PROSPERO, ID: CRD42022347987.
KW - Acute coronary syndrome
KW - Meta-analysis and systematic review
KW - Mortality
KW - Socioeconomic deprivation
KW - Socioeconomic status
UR - http://www.scopus.com/inward/record.url?scp=85156101201&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2023.04.042
DO - 10.1016/j.ijcard.2023.04.042
M3 - Article
C2 - 37116760
AN - SCOPUS:85156101201
SN - 0167-5273
VL - 383
SP - 140
EP - 150
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -