Abstract 155: Low Individual and Regional Socioeconomic Status Delayed Time from Symptom Onset to Reperfusion Therapy and Increased Mortality in Patients with ST-Elevation Myocardial Infarction
Hypothesis: Rapid reperfusion therapy is important in ST elevation myocardial infarction (STEMI). Socioeconomic status(SES) could affect accessibility to medical care and outcome. The goal of this study is to assess the effect of individual and regional SES on symptom onset to PCI and ED mortality in STEMI patients.
Methods: We used data from ‘Hospital based Registration of Cardiovascular Disease in South Korea’ operated by Korean Centers for Disease Control and Prevention. We enrolled STEMI cases between Nov. 2007 and Dec. 2010. Cases were excluded if educational level, address and time profile was missing. We assessed individual SES using educational level classified by ‘low: not educated or elementary school’ and ‘middle: middle or high school’ and ‘high : university graduated’. We also classified regional SES by three level using deprivation index of the address of each cases. We defined low SES group by low educational level and high deprivation index. And High SES group was defined by high educational level and low deprivation index. Primary outcome is association of SES level and time from symptom onset to PCI. Secondary outcome is ED mortality. We assessed clinical variable and time profile, descriptively. We compared median time of symptom onset to PCI between high and low SES groups by the Mann-Whitney Test. We assessed relative risk of ED mortality between two groups.
Results: During study period, 31 EDs inputted data of 8,635 STEMI patients and 6,583 patient were enrolled according to inclusion criteria. Low SES group with low education and high deprivation index were 860 (13.1%) patients and high SES group was 505 (7.7%) patients. ED mortality of low SES group was 2.9% and high group was 0.6%. Relative risk of ED mortality in low SES group compared with high group was 4.89 (95% CI: 1.49-16.1). Median time from symptom onset to PCI in low SES group was longer, 354 minutes (IQR: 186-1192) compared with 224 minutes in high group (IQR : 129-600) (p<0.05).
Conclusion: Low SES status measured by combination of individual and regional level delayed symptom onset to PCI and increased ED mortality.
Author Disclosures: J. Heo: None. K. Hong: None. S. Shin: None. K. Song: None.
- © 2014 by American Heart Association, Inc.