Gender, socioeconomic position, revascularization procedures and mortality in patients presenting with STEMI and NSTEMI in the era of primary PCI. Differences or inequities?

Gnavi, Roberto; Rusciani, Raffaella; Dalmasso, Marco; Giammaria, Massimo; Anselmino, M.; Roggeri, Daniela Paola; Roggeri, Alessandro

doi:10.1016/j.ijcard.2014.07.107

Cited by 41 publications

(27 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We identified studies conducted in Norway [16], Denmark [17], Finland [18, 19], and Italy [14, 15]. Overall, our findings are consistent with existing evidence, which showed a higher risk of death for lower educated patients, despite the efforts to promote equal access to health care typical of universal health care systems.…”

Section: Discussionsupporting

confidence: 85%

“…Overall, our findings are consistent with existing evidence, which showed a higher risk of death for lower educated patients, despite the efforts to promote equal access to health care typical of universal health care systems. Interestingly, the only studies showing a weak and inconsistent effect of individual education on short-term fatality were conducted in Italy [14, 15]. However, other Italian studies, which used SES indicators but not education, confirmed SES inequalities in patients with AMI [47, 49, 50].…”

Section: Discussionmentioning

confidence: 99%

“…In order to avoid selection bias, we selected the first AMI episode [14, 15, 17], and only included patients that had a baseline evaluation of 1 year with no AMI. For the readmission analysis, we considered only unplanned readmission and excluded patients only if they died during hospitalization (1221), not if they were alive at least 30 days after discharge, in line with similar studies, the Centers for Medicare & Medicaid Services, and the Tuscan Outcome Program [9, 28, 29].…”

Section: Methodsmentioning

confidence: 99%

“…Moreover, 30-day mortality and 30-day readmission are dichotomous outcomes, indicating whether or not the patient died or was readmitted within 30 days. Logistic regression models match the dichotomous nature of our outcomes and have been extensively used by other scholars for short-term outcomes [9, 15, 31]. In order to test an alternative specification, we also performed survival models.…”

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Educational level and 30-day outcomes after hospitalization for acute myocardial infarction in Italy

Cafagna

Seghieri

2017

BMC Health Serv Res

View full text Add to dashboard Cite

BackgroundThere is a growing interest in the factors that influence short-term mortality and readmission after hospitalization for acute myocardial infarction (AMI) since such outcomes are commonly considered as hospital performance measures. Socioeconomic status (SES) is one of the factors contributing to healthcare outcomes after hospitalization for AMI. However, no study has been published on education and 30-day readmission in Europe. The objective of this study is to examine the association between educational level and 30-day mortality and readmission among patients hospitalized for AMI in Tuscany (Italy).MethodsA retrospective cohort study using data from hospital discharge records was conducted. The analysis included all patients discharged with a principal diagnosis of AMI between January 1, 2011, and November 30, 2014, from all hospitals in Tuscany. Educational level was categorized as low (no middle school diploma), mid (middle school diploma) and high (high school diploma or more). Three multilevel models were developed, sequentially controlling for patient-level socio-demographic and clinical variables and hospital-level variables. Patients were stratified by age (≤75 and >75 years).ResultsMortality analysis included 23,402 patients, readmission analysis included 22,181 patients. In both unadjusted and full-adjusted models, patients with a high education had lower odds of 30-day mortality compared to those patients with low education (OR age ≤ 75 years 0.67, 95% CI:0.47–0.94; OR age > 75 years 0.72, 95% CI:0.54–0.95). With regard to 30-day readmission, only patients aged over 75 years with a high education had lower odds of short-term readmission compared to those patients with low education (OR age > 75 0.73, 95% CI:0.58–0.93).ConclusionsAmong patients hospitalized in Tuscany for AMI, low levels of education were associated with increased odds of 30-day mortality for both age groups and increased odds of 30-day readmission only for patients aged over 75 years. Our findings suggest that the educational component should not be underestimated in order to improve short-term outcomes, which are considered as performance measures at the hospital level. Hospital managers might consider strategies that are sensitive to patients with low SES, such as providing post-hospitalization support to less-educated patients and promoting a healthier lifestyle, to improve both health equity and performance outcomes.

show abstract

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Educational level and 30-day outcomes after hospitalization for acute myocardial infarction in Italy

Cafagna

Seghieri

2017

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…105 After AMI, women are less likely than men to receive ACE inhibitors, angiotensin receptor blockers, and β-blockers after discharge. 106 Women are less likely to receive primary PCI or CABG, 107 have longer symptom-onset-to-balloon time, more likely to receive only medical management, less likely to receive β-blockers or statins at discharge. 108 AHA's first Scientific Statement on Acute MI in Women, 109 notes that "despite dramatic declines in cardiovascular deaths among women over the past decade .…”

Section: Resultsmentioning

confidence: 99%

Because Women’s Lives Matter, We Need to Eliminate Gender Bias

2017

Critical Care Nurse

View full text Add to dashboard Cite

Using written vignettes of homicides that differed only in sex of perpetrator, forensic psychiatrists and students diagnosed the defendant as legally insane significantly more often when perpetrator was a woman. 11World Health Organization 12 and US 13 research found most behavioral disorders (depression, anxiety) are diagnosed twice as often in women.Men receive more intensive treatments than women for common conditions. 14 85% of men vs 55% of women receive oral antihyperglycemics. 15 Despite the UK NICE guideline 27 13,16 (mandates "urgent referral to an oncologist" for painless macroscopic hematuria), 27% of women vs 10% of men had multiple consults before referral. Bladder cancer 5-year survival rate is 57% for men, 44% for women. 17,18 Female gender is independent risk factor for delayed referral and diagnosis of bladder and renal cancer. 19 TKA referral in patients with comparable osteoarthritis severity: physicians deny sex influences referral, but referral rate for men is 3 times that for women. Using identical standardized patients, 42% of physicians recommended TKA for the male, but not the female. Odds of primary care physicians recommending TKA for men was twice that for women; for orthopedic physicians, odds for men was 22 times that for women. 20Patients with osteoarthritis needing hip replacement, women less likely than men to receive 4 of 5 care stages: consult with general practitioner, specialist referral, orthopedic consult, wait listed. 21 Women have more disability before referral. 22Women have lower probability of referral to waiting list for kidney transplantation and longer delay between dialysis and waiting list compared to men. 23-25Women had significantly lower liver transplantation rates than men from 1997 to 2007 and greater deficit to men since. 26Women had pain years longer than men before referral to pain clinic, where women are prescribed minor tranquilizers, sedatives, or antidepressants vs analgesics and opioids for men. 27After abdominal surgery, physicians prescribed less pain medication for women compared to men; nurses gave less pain medication to women. 28After CABG, men received narcotics, women given sedatives. 29First report on gender attributes of pain: physicians minimized women's pain by attributing it to emotional causes. 30 80 physicians (44 men) and 113 nurses (103 women) more likely to treat male patients with opioids than females. Disparity greater for nurses than physicians. 31Despite ACC/AHA PAD guidelines, at discharge, women are significantly less likely than men to be prescribed 3 recommended therapies: statins, aspirin, and β-blockers. 32,33Women are offered surgical revascularization less often (36.4%) than men (53.8%) and are offered CEA less often at all ages. 34 When CEA is offered to women, it is often on a very delayed basis. Delays persist after adjusting for age, history, preoperative TIA, ABCD2 score, degree of stenosis, unilateral symptoms, and symptomatic stenosis. 34 Findings most concerning because female gender is a known, negative, independ...

show abstract

Area-based socioeconomic status and mortality: the Ludwigshafen Risk and Cardiovascular Health study

et al. 2019

View full text Add to dashboard Cite

Gender, socioeconomic position, revascularization procedures and mortality in patients presenting with STEMI and NSTEMI in the era of primary PCI. Differences or inequities?

Cited by 41 publications

References 36 publications

Educational level and 30-day outcomes after hospitalization for acute myocardial infarction in Italy

Educational level and 30-day outcomes after hospitalization for acute myocardial infarction in Italy

Because Women’s Lives Matter, We Need to Eliminate Gender Bias

Area-based socioeconomic status and mortality: the Ludwigshafen Risk and Cardiovascular Health study

Contact Info

Product

Resources

About