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首页> 外文期刊>Annals of epidemiology >Socioeconomic environment and recurrent coronary events after initial myocardial infarction
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Socioeconomic environment and recurrent coronary events after initial myocardial infarction

机译：初始心肌梗死后的社会经济环境和冠心病复发

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Purpose: Longitudinal data linking area-level socioeconomic status (SES) to repeated acute coronary syndrome (ACS) events are limited. Using multiple failure-time data, we examined the association between neighborhood SES and ACS in a community-based cohort of myocardial infarction (MI) survivors. Methods: Consecutive patients aged 65 years or younger discharged from eight hospitals in central Israel after first MI in 1992-1993 were followed through 2005. Recurrent MI and unstable angina pectoris (UAP) leading to hospitalization were recorded. Neighborhood SES was assessed through a composite census-derived index developed by the Israel Central Bureau of Statistics. Different variance-corrected proportional hazards models were used to account for multiple recurrent events: Andersen-Gill, Wei-Lin-Weissfeld (WLW), and Prentice-Williams-Peterson. Results: During follow-up, 531 recurrent MIs and 1584 UAP episodes occurred among 1164 patients. Adjusting for known prognostic factors and individual SES using the Andersen-Gill model, higher estimated hazards were associated with poor neighborhood SES (hazard ratio, 1.55; 95% confidence interval [CI], 1.13-2.14 for recurrent MI; and hazard ratio, 1.48; 95% CI, 1.22-1.79 for UAP; in the 5th vs. 95th percentiles). The WLW and Prentice-Williams-Peterson models yielded similar results. When the two outcomes were combined, the WLW-derived hazard ratio was 1.64 (95% CI, 1.39-1.93). Conclusions: MI survivors living in a deprived neighborhood are at higher risk of repeated hospital admissions because of ACS. Secondary prevention initiatives should incorporate multilevel approaches to increase effectiveness and reduce geographic health disparities.
机译：目的：将地区一级的社会经济地位（SES）与反复的急性冠状动脉综合征（ACS）事件相关联的纵向数据是有限的。使用多个失败时间数据，我们在社区性心肌梗死（MI）幸存者队列中检查了邻域SES和ACS之间的关联。方法：对1992-1993年首次MI后从以色列中部八家医院出院的65岁及以下的连续患者进行随访，直至2005年。记录复发的MI和不稳定型心绞痛（UAP）导致住院。以色列中央统计局通过人口普查衍生的综合指数评估了邻里SES。使用不同的经方差校正的比例风险模型来解释多个复发事件：Andersen-Gill，Wei-Lin-Weissfeld（WLW）和Prentice-Williams-Peterson。结果：在随访期间，在1164例患者中发生了531例MI复发和1584例UAP发作。使用Andersen-Gill模型调整已知的预后因素和个体SES，较高的估计危险与差的邻里SES相关（危险比，1.55; 95％置信区间[CI]，复发MI的危险度1.13-2.14;危险比，1.48） ; 95％CI，UAP为1.22-1.79;在第5个百分点和第95个百分点之间）。 WLW和Prentice-Williams-Peterson模型产生了相似的结果。当两个结果合并时，WLW得出的风险比为1.64（95％CI，1.39-1.93）。结论：生活在贫困地区的MI幸存者由于ACS再次住院的风险较高。二级预防措施应纳入多层次的方法，以提高有效性并减少地理健康差异。

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