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Social, economic factors impact mortality rates 10 years after CABG
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Social factors have a strong association with mortality risk in patients after CABG, according to findings published in the Journal of the American Heart Association.
Susanne Nielsen, RN, PhD, and colleagues sought to determine whether there were sex- and age-specific associations between mortality risk after CABG and marital status, income and education.
“Accordingly, several social factors have been shown to be important in long-term survival after cardiac procedures,” Nielsen, of the department of molecular and clinical medicine at Sahlgrenska Academy at Gothenburg University in Sweden, and colleagues wrote. “Still, few studies have been adequately powered to examine the impact of several factors such as education, marital status, household income and mortality simultaneously.”
The researchers analyzed data from the SWEDEHEART registry between 1992 and 2015 consisting of 110,742 patients who had CABG (21.3% women). Cox regression models were used to study the relation between social factors and all-cause mortality.
Never having been married compared with being married/cohabiting was associated with a higher mortality risk in women than in men (HR = 1.32; 95% CI, 1.2-1.44 vs. HR = 1.17; 95% CI, 1.13-1.22; P for interaction = .03), Nielsen and colleagues reported.
In the lowest income quartile, there was a greater degree of mortality risk in men than in women (HR = 1.44; 95% CI, 1.38-1.51) compared with the highest income quartile (HR = 1.25; 95% CI, 1.14-1.38; P for interaction = .0036), the researchers wrote.
Mortality risk was greater in men (HR = 1.15; 95% CI, 1.11-1.19) and women (HR = 1.25; 95% CI, 1.16-1.35) with the lowest education compared with men and women with the highest level of education with no significant interaction between education and sex, Nielsen and colleagues wrote.
In unmarried women aged 60 years at surgery with low income and low education, mortality 10 years after surgery was greater compared with married women with high income and higher education (18% vs. 11%), the researchers wrote. The median life expectancy was 4.8 years shorter.
Unmarried men aged 60 years at surgery with low income and low education had a greater mortality risk compared with married men with high income and higher education (21% vs. 12%; 5 years shorter life expectancy), according to Nielsen and colleagues.
There is room for improvement in educational approaches to increase patients’ knowledge of the importance of secondary prevention, especially in patients with the highest burden of social disadvantages, they wrote.
“Future research should focus on the impact of how different pedagogical approaches affect patients’ adherence to secondary prevention and whether this leads to reduced mortality, specifically in vulnerable groups undergoing CABG,” Nielsen and colleagues wrote – by Earl Holland Jr.
Disclosures: The authors report no relevant financial disclosures.
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