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Social Determinants of Health and Mortality After Premature and Non-premature Acute Coronary Syndrome

Dugani, S. B. ORCID: 0000-0001-7858-1317, Zubaid, M., Rashed, W. , Girardo, M. E., Balayah, Z. ORCID: 0000-0001-5389-494X, Mora, S. ORCID: 0000-0001-6283-0980 & Alsheikh-Ali, A. A. ORCID: 0000-0002-1213-4546 (2023). Social Determinants of Health and Mortality After Premature and Non-premature Acute Coronary Syndrome. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 7(3), pp. 153-164. doi: 10.1016/j.mayocpiqo.2023.03.002

Abstract

Objective
To describe and compare the determinants of 1-year mortality after premature vs non-premature acute coronary syndrome (ACS).

Patients and Methods
Participants presenting with ACS were enrolled in a prospective registry of 29 hospitals in 4 countries, from January 22, 2012 to January 22, 2013, with 1-year of follow-up data. The primary outcome was all-cause 1-year mortality after premature ACS (men aged <55 years and women aged <65 years) and non-premature ACS (men aged ≥55 years and women aged ≥65 years). The associations between the baseline patient characteristics and 1-year mortality were analyzed in models adjusting for the Global Registry of Acute Coronary Events (GRACE) score and reported as adjusted odds ratio (aOR) (95% CI).

Results
Of the 3868 patients, 43.3% presented with premature ACS that was associated with lower 1-year mortality (5.7%) than those with non-premature ACS. In adjusted models, women experienced higher mortality than men after premature (aOR, 2.14 [1.37-3.41]) vs non-premature ACS (aOR, 1.28 [0.99-1.65]) (Pinteraction=.047). Patients lacking formal education vs any education had higher mortality after both premature (aOR, 2.92 [1.87-4.61]) and non-premature ACS (aOR, 1.78 [1.36-2.34]) (Pinteraction=.06). Lack of employment vs any employment was associated with approximately 3-fold higher mortality after premature and non-premature ACS (Pinteraction=.72). Using stepwise logistic regression to predict 1-year mortality, a model with GRACE risk score and 4 characteristics (education, employment, body mass index [kg/m2], and statin use within 24 hours after admission) had higher discrimination than the GRACE risk score alone (area under the curve, 0.800 vs 0.773; Pcomparison=.003).

Conclusion
In this study, women, compared with men, had higher 1-year mortality after premature ACS. The social determinants of health (no formal education or employment) were strongly associated with higher 1-year mortality after premature and non-premature ACS, improved mortality prediction, and should be routinely considered in risk assessment after ACS.

Publication Type: Article
Additional Information: © 2023 THE AUTHORS. Published by Elsevier Inc on behalf of Mayo Foundation for Medical Education and Research. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Subjects: H Social Sciences > HM Sociology
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RC Internal medicine
Departments: Bayes Business School
Bayes Business School > Faculty of Management
SWORD Depositor:
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