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.
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).
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.
The current study was registered with PROSPERO, ID: CRD42022347987.
方法:使用多维指数搜索Medline和Embase报告通过SES分层的ACS患者结局的文章,至少包括以下两个组成部分:收入,教育和就业。使用随机效应模型进行了比较荟萃分析,以估计低SES与高SES人群的全因死亡率风险比。根据地理区域分层,学习年,随访持续时间和SES指数。
结果:共纳入29项研究,包括301,340名个体,其中43.7%被归类为低SES。虽然两个SES组的患者具有相似的心血管风险特征,与高SES患者相比,低SES患者的全因死亡率风险明显更高(调整后的HR:1.19,95CI:1.10-1.1.29,p<0.001)。1年死亡率较高(RR:1.08,95CI:1.03-1.13,p=0.0057),但30天死亡率较高(RR:1.07,95CI:0.98-1.16,p=0.1003)。尽管ST段抬高型心肌梗死和非ST段抬高型ACS的发生率相似,SES低的个体冠状动脉血运重建率较低(RR:0.95,95CI:0.91-0.99,p=0.0115),脑血管意外风险较高(RR:1.25,95CI:1.01-1.55,p=0.0469).超额死亡风险与地区无关(p=0.2636),研究年份(p=0.7271)和随访时间(p=0.0604),但取决于所使用的SES指数(p<0.0001).
结论:低SES与ACS后死亡率增加相关,与高SES相比,冠状动脉血运重建率欠佳。需要作出协调一致的努力,以解决与ACS有关的全球社会经济不平等问题。
■当前的研究已在PROSPERO注册,ID:CRD42022334482。