Abstract 4183: Gender Difference in the Relationship Between Socioeconomic Deprivation and Fatal Compared to Non-fatal Myocardial Infarction
Introduction: Although socioeconomic deprivation (SED) has been identified as an important risk factor for myocardial infarction (MI), it is not clear whether it predicts outcome after adjustment for traditional risk factors. The relative importance of SED as a predictor of fatal versus non-fatal outcomes and in men versus women is also uncertain.
Hypothesis: We hypothesized that SED is an independent predictor of both first hospitalization for MI and MI death (and equally so in men and women).
Methods: We examined outcomes in 15,378 men and women initially surveyed between 1972–76 in Renfrew and Paisley, Scotland, and followed until 3/31/2004. Hazards ratios (HR) for a first admission with a MI (as principal diagnosis) and death from MI were calculated using Cox Regression. All analyses were adjusted for age, body mass index, systolic and diastolic blood pressure, cholesterol, smoking, ECG ischemia, and a history of diabetes, angina or stroke. Deprivation was defined using the seven category Carstairs deprivation index. Deprivation categories (depcat) 6 and 7 (the most deprived depcats) were combined to increase power due to small numbers of individuals in group 7. Log rank tests were used to compare the overall trend across depcats.
Results: During >=28 years follow-up, 1873 men and women had a first MI hospitalization and 2370 a MI death. Compared to the most affluent (depcat 1), the risk of MI death in men and women combined in depcat 6/7 was 37% higher (hazard ratio (HR) 1.37 (P=0.001)), trend P<0.0001. The HR for men alone in depcat 6/7 versus depcat 1 was 1.35 (P=0.018) and similarly 1.38 for women alone (P=0.027). For men and women in depcat 6/7 (compared to depcat 1), the HR for a first MI hospitalization was 1.34 (P= 0.007), P<0.0001. The HR was 1.1 for men (P=0.5) and 1.74 for women (P=0.002).
Conclusion: SED is associated with an increased risk of MI death which is of similar magnitude in men and women, even after accounting for “traditional” risk factors. By contrast, SED is associated with a smaller risk of 1st hospitalization for MI in men than women. This explanation for this gender difference is uncertain but may represent a differential effect of SED on survival to hospital admission in men and women.