Short and Long Term Mortality after Coronary Artery Bypass Grafting (CABG) Is Influenced by Socioeconomic Position but Not by Migration Status in Sweden, 1995–2007

Dashti Ali M Dzayee,Torbjörn Ivert,Omid Beiki,Lars Alfredsson,Tahereh Moradi,Rickard Ljung,Kelvin Kian Loong Wong

doi:10.1371/journal.pone.0063877

Abstract

BackgroundThere are no nationwide studies on mortality after coronary artery bypass grafting (CABG) among foreign-born populations that include detailed information about country of birth and information about socioeconomic position. The objective was to investigate the risk of mortality after CABG considering socioeconomic position, sex and country of birth.Material and MethodsWe included all 72 333 patients undergoing a first isolated CABG in Sweden, during 1995 - 2007 of whom 12.7% were foreign-born. The patients were classified according to educational level, sex, and country of birth and were followed up to December 2007. We estimated the risk of short and long term mortality after CABG in a multivariable model adjusted for age, calendar year of surgery, diabetes, educational level, and waiting time for surgery. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated based on the Cox proportional hazard model.FindingsThere were 15,284 deaths during the follow-up, 10.4% of whom were foreign-born. The foreign-born patients were 3 to 4 years younger than Sweden-born patients at the time of CABG surgery. There were no significant differences in overall early or late mortality between foreign-born and Sweden-born men and women after CABG. All-cause mortality differed in between regions and was highest in foreign-born men from Eastern Africa (HR 3.80, 95% CI 1.58–9.17), China (HR 3.61, 95% CI 1.50–8.69), and in Chile (HR 2.12, 95% CI 1.01–4.47). Patients with low level of education had worse survival compared to those with longer than 12 years of education irrespective of sex and country of birth. This difference was more pronounced among foreign-born women (HR 1.50, 95% CI 1.00–2.33).ConclusionThis national study showed higher CABG mortality in patients from lower socioeconomic position. Early and late mortality did not differ after isolated CABG in foreign-born and Sweden-born patients.

Highlights

Atherosclerosis is the major underlying cause responsible for adverse cardiovascular outcome including transient ischemic attack, stroke, and coronary arterial disease (CAD) [1]
We evaluated short and long-term mortality after coronary artery bypass grafting (CABG) in Sweden in relation to socioeconomic position (SEP), sex and country of birth using a variety of Swedish national registers
The ethical vetting is performed by regional ethical review boards and the risk appraisal associated with the Law on Public Disclosure and Secrecy is done by data holders

Summary

Introduction

Atherosclerosis is the major underlying cause responsible for adverse cardiovascular outcome including transient ischemic attack, stroke, and coronary arterial disease (CAD) [1]. It is a chronic process and with the configurations of the plaque formation and atherosclerotic stenosis can lead to final plaque rupture [2,3,4,5]. There are no nationwide studies on mortality after coronary artery bypass grafting (CABG) among foreignborn populations that include detailed information about country of birth and information about socioeconomic position. The objective was to investigate the risk of mortality after CABG considering socioeconomic position, sex and country of birth

Methods

Results

Discussion

Conclusion