Association of marital/partner status with hospital readmission among young adults with acute myocardial infarction

• Published in: PloS one 2024-01, Vol.19 (1), p.e0287949
• Main Authors: Zhu, Cenjing, Dreyer, Rachel P, Li, Fan, Spatz, Erica S, Caraballo, César, Mahajan, Shiwani, Raparelli, Valeria, Leifheit, Erica C, Lu, Yuan, Krumholz, Harlan M, Spertus, John A, D'Onofrio, Gail, Pilote, Louise, Lichtman, Judith H
• Format: Article
• Language: English
• Subjects: Adults; Age; Analysis; Cardiovascular disease; Care and treatment; Chronic obstructive pulmonary disease; Complications and side effects; Demographics; Demography; Diagnosis; Divorce; Education; Female; Health aspects; Health insurance; Heart; Heart attack; Heart attacks; Hospital care; Hospitals; Humans; Husband and wife; Ischemia; Kinases; Male; Marriage; Mediation; Medical records; Mental depression; Middle Aged; Mortality; Myocardial infarction; Myocardial Infarction - epidemiology; Patient Readmission; Patients; Prevention; Psychological aspects; Risk Factors; Secondary schools; Sensitivity analysis; Sex differences; Social aspects; Social support; Socioeconomic Factors; Socioeconomics; Statistical models; Teenagers; Variables; Women; Young Adult; Young adults; Youth
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0287949

Despite evidence supporting the benefits of marriage on cardiovascular health, the impact of marital/partner status on the long-term readmission of young acute myocardial infarction (AMI) survivors is less clear. We examined the association between marital/partner status and 1-year all-cause readmission and explored sex differences among young AMI survivors. Data were from the VIRGO study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients), which enrolled young adults aged 18-55 years with AMI (2008-2012). The primary end point was all-cause readmission within 1 year of hospital discharge, obtained from medical records and patient interviews and adjudicated by a physician panel. We performed Cox proportional hazards models with sequential adjustment for demographic, socioeconomic, clinical, and psychosocial factors. Sex-marital/partner status interaction was also tested. Of the 2,979 adults with AMI (2002 women [67.2%]; mean age 48 [interquartile range, 44-52] years), unpartnered individuals were more likely to experience all-cause readmissions compared with married/partnered individuals within the first year after hospital discharge (34.6% versus 27.2%, hazard ratio [HR] = 1.31; 95% confidence interval [CI], 1.15-1.49). The association attenuated but remained significant after adjustment for demographic and socioeconomic factors (adjusted HR, 1.16; 95% CI, 1.01-1.34), and it was not significant after further adjusting for clinical factors and psychosocial factors (adjusted HR, 1.10; 95%CI, 0.94-1.28). A sex-marital/partner status interaction was not significant (p = 0.69). Sensitivity analysis using data with multiple imputation and restricting outcomes to cardiac readmission yielded comparable results. In a cohort of young adults aged 18-55 years, unpartnered status was associated with 1.3-fold increased risk of all-cause readmission within 1 year of AMI discharge. Further adjustment for demographic, socioeconomic, clinical, and psychosocial factors attenuated the association, suggesting that these factors may explain disparities in readmission between married/partnered versus unpartnered young adults. Whereas young women experienced more readmission compared to similar-aged men, the association between marital/partner status and 1-year readmission did not vary by sex.