Abstract 3700: Influence of Socioeconomic Status on Lifestyle Behaviour Modifications Among Survivors of Acute Myocardial Infarction
Background: The survival impact of secondary prevention initiatives on improving survival among higher-risk socioeconomically-disadvantaged patients after acute myocardial infarction (AMI) may depend upon behavioral adaptive responsiveness, uptake, and adherence to healthier lifestyles.
Methods: We recruited 3506 patients hospitalized for AMI from 53 large-volume institutions in Ontario, Canada between December 1999 and February 2003. Self-reported measures of income and education were obtained by survey. Baseline cardiovascular risk and non-cardiac comorbidities were obtained through chart data. A baseline survey and a 30-day telephone interview was used to assess health behaviours before and after AMI. These behaviours were examined with and without adjustments for age, gender, ethnicity, income, cardiovascular history and risk, and other comorbidities to look for relationships with baseline characteristics as well as 2 year mortality.
Results: There were significant differences in lifestyle behaviour after AMI between SES groups. In the first month after their AMI, after adjusting for baseline characteristics, patients in the highest income tertile compared to those in the lowest income tertile were significantly less likely to smoke (adjusted OR for highest vs. lowest income tertiles, 0.37 [95% CI, 0.22– 0.63]; p<0.001), more likely to participate in exercise (adjusted OR 1.39 [95% CI, 1.06 –1.82]; p=0.02), and more likely to reduce or discontinue alcohol use (adjusted OR 1.50 [95% CI, 1.07–2.11], p=0.02). Dietary modification was not significantly different between the groups. After adjustment for baseline factors, there was no relationship between SES and mortality. However, mortality at 2 years was significantly decreased in patients who had regular participation in physical exercise at 1 month (adjusted OR 0.50, 95% C.I. 0.30 – 0.82, P=0.006)
Conclusions: Socioeconomic-behavioral differences in the uptake of healthy life-style behaviors after AMI underscore additional challenges in mitigating cardiovascular “health-wealth” gradients, and may necessitate a more targeted, selective, and intensive approach to the provision of chronic secondary prevention initiatives to patients in lower socioeconomic populations.