Temporal trends in socioeconomic disparity in clinical outcomes for patients with acute coronary syndrome

• Published in: Cardiovascular revascularization medicine 2023-11, Vol.56, p.64-72
• Main Authors: Simoni, Amalie H., Valentin, Jan B., Kragholm, Kristian H., Bøggild, Henrik, Jensen, Svend E., Johnsen, Søren P.
• Format: Article
• Language: English
• Subjects: Acute coronary syndrome; Major adverse cardiac events; Socioeconomic disparity
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2023.05.012

Socioeconomic factors are well-established determinants of clinical outcomes among patients with acute coronary syndrome (ACS) although quality of care has improved the last decades. This study aims to investigate 20-years temporal trends of socioeconomic disparity in 1-year incidence of major adverse cardiac events (MACE) among ACS patients in Denmark. This population-based cohort study included all incident ACS patients in the Danish National Patient Registry during 1998–2017. Socioeconomic disparity was assessed by income and educational level. Patients were followed 1-year for MACE; defined as all-cause mortality, recurrent ACS, revascularization, stroke, or cardiac arrest. Adjusted MACE incidence rates (aIR) and hazard rate ratios (aHR) were computed with 95 % confidence intervals (CI) for five-year-periods. Changes in trends were examined from interaction analyses between the HR for five-year-periods and income and education, respectively. The study included 220,887 patients with first-time ACS. The incidence of MACE decreased within all income and education levels. In 1998–2002 the MACE aIR among patients with low income was 885[95%CI:863–907] versus 733[711–756]/1000-person-year among those with high income (aHR: 1.19[95%CI:1.15–1.23]). The aIRs decreased to 506[489–522] and 405[388–423]/1000-person-year, respectively, in 2013–2017 (aHR: 1.23[1.17–1.29]). The aIRs of MACE decreased correspondingly within all educational levels from 1998 to 2002 to 2013–2017. However, the socioeconomic disparity according to the interaction analyses persisted both according to income and educational level. Although 1-year clinical outcomes following ACS has improved substantially over the last decades, socioeconomic disparity persisted both according to income and education level. [Display omitted] •30-days and 1-year clinical outcomes following ACS has improved substantially over the last decades.•Outcomes following ACS has improved among patients within all levels of income and education.•Socioeconomic disparity in severe clinical outcomes after ACS persisted across the 20-years.