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

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

Kent and Medway Medical School (KMMS)

Lee Kong Chian School of Medicine
National University of Singapore
Royal College of Surgeons in Ireland
MOH Holdings Pte Ltd.
National University Hospital
King's College London
King's College Hospital NHS Foundation Trust
Virginia Commonwealth University
Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease
Tianjin Medical University
School of Nursing and Health Studies
Hong Kong Metropolitan University
The University of Sydney
Royal North Shore Hospital
Keele University
University of Manchester

Research output: Contribution to journal › Article › peer-review

24 Citations (Scopus)

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.

Original language	English
Pages (from-to)	140-150
Number of pages	11
Journal	International Journal of Cardiology
Volume	383
DOIs	https://doi.org/10.1016/j.ijcard.2023.04.042
Publication status	Published - 15 Jul 2023

Keywords

Acute coronary syndrome
Meta-analysis and systematic review
Mortality
Socioeconomic deprivation
Socioeconomic status

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10.1016/j.ijcard.2023.04.042

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Anand, V. V., Zhe, E. L. C., Chin, Y. H., Goh, R. S. J., Lin, C., Kueh, M. T. W., Chong, B., Kong, G., Tay, P. W. L., Dalakoti, M., Muthiah, M., Dimitriadis, G. K., Wang, J. W., Mehta, A., Foo, R., Tse, G., Figtree, G. A., Loh, P. H., Chan, M. Y., ... Chew, N. W. S. (2023). Socioeconomic deprivation and prognostic outcomes in acute coronary syndrome: A meta-analysis using multidimensional socioeconomic status indices. International Journal of Cardiology, 383, 140-150. https://doi.org/10.1016/j.ijcard.2023.04.042

@article{2deeabb9d94d4e5898a41f888770d3ff,

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

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",

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

note = "Publisher Copyright: {\textcopyright} 2023 Elsevier B.V.",

year = "2023",

month = jul,

day = "15",

doi = "10.1016/j.ijcard.2023.04.042",

language = "English",

volume = "383",

pages = "140--150",

journal = "International Journal of Cardiology",

issn = "0167-5273",

publisher = "Elsevier Ireland Ltd",

}

Anand, VV, Zhe, ELC, Chin, YH, Goh, RSJ, Lin, C, Kueh, MTW, Chong, B, Kong, G, Tay, PWL, Dalakoti, M, Muthiah, M, Dimitriadis, GK, Wang, JW, Mehta, A, Foo, R, Tse, G, Figtree, GA, Loh, PH, Chan, MY, Mamas, MA & Chew, NWS 2023, 'Socioeconomic deprivation and prognostic outcomes in acute coronary syndrome: A meta-analysis using multidimensional socioeconomic status indices', International Journal of Cardiology, vol. 383, pp. 140-150. https://doi.org/10.1016/j.ijcard.2023.04.042

TY - JOUR

T1 - Socioeconomic deprivation and prognostic outcomes in acute coronary syndrome

T2 - A meta-analysis using multidimensional socioeconomic status indices

AU - Anand, Vickram Vijay

AU - Zhe, Ethan Lee Cheng

AU - Chin, Yip Han

AU - Goh, Rachel Sze Jen

AU - Lin, Chaoxing

AU - Kueh, Martin Tze Wah

AU - Chong, Bryan

AU - Kong, Gwyneth

AU - Tay, Phoebe Wen Lin

AU - Dalakoti, Mayank

AU - Muthiah, Mark

AU - Dimitriadis, Georgios K.

AU - Wang, Jiong Wei

AU - Mehta, Anurag

AU - Foo, Roger

AU - Tse, Gary

AU - Figtree, Gemma A.

AU - Loh, Poay Huan

AU - Chan, Mark Y.

AU - Mamas, Mamas A.

AU - Chew, Nicholas W.S.

PY - 2023/7/15

Y1 - 2023/7/15

N2 - 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.

AB - 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.

KW - Acute coronary syndrome

KW - Meta-analysis and systematic review

KW - Mortality

KW - Socioeconomic deprivation

KW - Socioeconomic status

UR - https://www.scopus.com/pages/publications/85156101201

U2 - 10.1016/j.ijcard.2023.04.042

DO - 10.1016/j.ijcard.2023.04.042

M3 - Article

C2 - 37116760

AN - SCOPUS:85156101201

SN - 0167-5273

VL - 383

SP - 140

EP - 150

JO - International Journal of Cardiology

JF - International Journal of Cardiology

ER -

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

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Keywords

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