Abstract：
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.
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.
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.
摘要：
背景：低社会经济地位（SES）是急性冠脉综合征（ACS）患者的重要预后因素。本文分析了SES对ACS结局的影响。
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。
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。
