Socioeconomic deprivation and prognostic outcomes in acute coronary syndrome: A meta-analysis using multidimensional socioeconomic status indices

Vickram Vijay Anand; Ethan Lee Cheng Zhe; Yip Han Chin; Rachel Sze Jen Goh; Chaoxing Lin; Martin Tze Wah Kueh; Bryan Chong; Gwyneth Kong; Phoebe Wen Lin Tay; Mayank Dalakoti; Mark Muthiah; Georgios K Dimitriadis; Jiong-Wei Wang; Anurag Mehta; Roger Foo; Gary Tse; Gemma A Figtree; Poay Huan Loh; Mark Y Chan; Mamas A Mamas; Nicholas W S Chew

doi:10.1016/j.ijcard.2023.04.042

Socioeconomic deprivation and prognostic outcomes in acute coronary syndrome: A meta-analysis using multidimensional socioeconomic status indices

Int J Cardiol. 2023 Jul 15:383:140-150. doi: 10.1016/j.ijcard.2023.04.042. Epub 2023 Apr 26.

Authors

Vickram Vijay Anand¹, Ethan Lee Cheng Zhe¹, Yip Han Chin², Rachel Sze Jen Goh³, Chaoxing Lin³, Martin Tze Wah Kueh⁴, Bryan Chong³, Gwyneth Kong³, Phoebe Wen Lin Tay³, Mayank Dalakoti⁵, Mark Muthiah⁶, Georgios K Dimitriadis⁷, Jiong-Wei Wang⁸, Anurag Mehta⁹, Roger Foo⁵, Gary Tse¹⁰, Gemma A Figtree¹¹, Poay Huan Loh⁵, Mark Y Chan⁵, Mamas A Mamas¹², Nicholas W S Chew¹³

Affiliations

¹ Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
² Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Yong Loo Lin School of Medicine, National University Singapore, Singapore.
³ Yong Loo Lin School of Medicine, National University Singapore, Singapore.
⁴ Royal College of Surgeons in Ireland and University College Dublin Malaysia Campus, Malaysia.
⁵ Yong Loo Lin School of Medicine, National University Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore.
⁶ Yong Loo Lin School of Medicine, National University Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore.
⁷ Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK; Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.
⁸ Yong Loo Lin School of Medicine, National University Singapore, Singapore; Department of Surgery, Cardiovascular Research Institute (CVRI), National University of Singapore, Singapore; Nanomedicine Translational Research Programme, Centre for NanoMedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁹ Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University Pauley Heart Centre, Richmond, VA, USA.
¹⁰ Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China; Kent and Medway Medical School, Kent, Canterbury CT2 7NT, UK; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China.
¹¹ Northern Clinical School, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia.
¹² Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke-on-Trent, UK; Institute of Population Health, University of Manchester, UK.
¹³ Department of Cardiology, National University Heart Centre, National University Health System, Singapore. Electronic address: nicholas_ws_chew@nuhs.edu.sg.

PMID: 37116760
DOI: 10.1016/j.ijcard.2023.04.042

Abstract

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.

Keywords: Acute coronary syndrome; Meta-analysis and systematic review; Mortality; Socioeconomic deprivation; Socioeconomic status.

Publication types

Meta-Analysis

MeSH terms

Acute Coronary Syndrome* / diagnosis
Acute Coronary Syndrome* / surgery
Humans
Low Socioeconomic Status
Prognosis
ST Elevation Myocardial Infarction*
Social Class