Socio-professional status as a major determinant of disparities in cardiovascular outcomes: contemporary data on the prognosis inof manual workersmen after an acute myocardial infarction

Abstract

Introduction: Over the last decade in France, the early prognosis after acute myocardial infarction (AMI) has markedly improved. However, recent work suggests persistent socioeconomic disparities in outcomes after AMI. From a regional population-based study, we analyzed the prognosis in manual workers after AMI. Patients: Patients recorded in the ObservatoiRe des Infarctus du myocarde de Cote d'Or (RICO) between 2001 and 2011, < 65 y, with a current professional activity and follow-up at one year. Socio-professional categories (SPC) were collected according to INSEE definition. The primary endpoint was combined mortality and hospitalization for heart failure. Results: Among the 1671 patients included during the study period, 403 (24%) were manual workers. Mean age was 50.8 years, 85% were male and 50% had ST-segment elevation MI (STEMI). Although manual workers have a more favorable pattern of risk factors, the combined endpoint in manual workers was 3 times that in other SPC (7.9% vs. 2.6%). Multivariate analysis showed that manual work remained strongly associated with a worse prognosis, even after adjustment for confounders (OR (95% CI): 3.22 (1.44-7.17)). Conclusion: This large contemporary study showed that the medium-term prognosis in manual workers after AMI was still worse than in other SPC in France. Socio-professional status is an important determinant of population health and cardiovascular outcomes and may account for some of the heterogeneity in outcomes in patients hospitalized for AMI.