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Healthcare Contacts after Myocardial Infarction According to Mental Health and Socioeconomic Position: A
Tine Jepsen Nielsen1, Mogens Vestergaard2, Morten Fenger-Grøn1
1Mental Health in Primary Care (MEPRICA), Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.
Insights
Patients with anxiety, depression, or lower socioeconomic status use healthcare differently after a first myocardial infarction (MI). Those with anxiety had more general practice visits, while those with depression or lower education had fewer hospital visits, despite poorer prognosis.
Area of Science:
- Cardiology
- Public Health
- Mental Health
Background:
- Myocardial infarction (MI) is a leading cause of mortality and morbidity worldwide.
- Post-MI recovery involves significant healthcare utilization, influenced by various patient factors.
- Understanding disparities in healthcare access and use is crucial for effective patient management.
Purpose of the Study:
- To investigate the association between mental health status (anxiety, depression) and socioeconomic position (education, cohabitation) and long-term healthcare utilization after a first-time myocardial infarction (MI).
Main Methods:
- A population-based cohort study involving 908 patients discharged with their first MI in the Central Denmark Region in 2009.
- Data collected via questionnaires and nationwide registers.
- Adjusted incidence rates and incidence rate ratios (IRR) were calculated for general practice (GP) and hospital contacts.
Main Results:
- Patients with anxiety symptoms showed a 24% increase in GP contacts post-MI.
- Patients with depressive symptoms, shorter education, or living alone had similar or fewer GP and hospital contacts compared to their counterparts.
- Anxiety symptoms were associated with more GP contacts, while depression, lower education, and living alone were linked to fewer hospital contacts in the initial post-MI period.
Conclusions:
- Patients with depressive symptoms, lower educational attainment, and those living alone demonstrated lower long-term healthcare contact rates following MI.
- Despite potentially higher healthcare needs due to poorer prognosis, these patient groups utilized healthcare services less frequently.
- Findings highlight potential inequities in post-MI care, necessitating targeted interventions for vulnerable populations.
Objective:
To examine the long-term use of healthcare contacts to general practice (GP) and hospital after a first-time myocardial infarction (MI) according to mental health and socioeconomic position.
Methods:
Population-based cohort study of all patients discharged with first-time MI in the Central Denmark Region in 2009 (n=908) using questionnaires and nationwide registers. We estimated adjusted incidence rates and incidence rate ratios (IRR) for GP and hospital contacts according to depressive and anxiety symptoms, educational level and cohabitation status.
Results:
During the 24-month period after the MI, patients with anxiety symptoms had 24% more GP contacts (adjusted IRR 1.24, 95% confidence interval (CI) 1.12-1.36) than patients with no anxiety symptoms. In contrast, patients with depressive symptoms (1.05, 0.94-1.16) and with short and medium education (<10 years: 0.96, 0.84-1.08; 10-12 years: 0.91, 0.80-1.03) and patients living alone (0.95, 0.87-1.04) had the same number of GP contacts as their counterparts (patients with no depressive symptoms, with long education [>12 years] and patients living with a partner). During the first 6 months after the MI, patients living alone had 13% fewer hospital contacts (0.87, 0.77-0.99), patients with short education had 16% fewer hospital contacts (<10 years: 0.84, 0.72-0.98) and patients with anxiety symptoms had 27% fewer hospital contacts (0.73, 0.62-0.86) than their counterparts. In contrast, patients with depressive symptoms (0.92, 0.77-1.10) and medium education (10-12 years: 1.05, 0.91-1.22) had the same number of hospital contacts as their counterparts.
Conclusions:
This study indicates that patients with depressive symptoms, short and medium education and patients living alone have a lower long-term use of healthcare contacts following MI than patients without these risk factors. Patients with depressive symptoms and low socioeconomic position would be expected to have a higher need of healthcare after MI as they have a poorer prognosis.
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