近所の社会経済的状況と,心筋梗塞後の長期生存率
Yariv Gerber1, Yael Benyamini, Uri Goldbourt
1Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, 69978, Israel. yarivg@post.tau.ac.il
Circulation
|January 13, 2010
まとめ
近所の社会経済的地位 (SES) は,心筋梗塞 (MI) の後の生存率に大きく影響します. 個人的な要因を考慮しても,恵まれない地域に住むことは,心筋梗塞の患者の死亡リスクを増大させる.
科学分野:
- 心血管伝染病学 心血管伝染病学
- 健康の社会的決定因子
- 公共衛生は公衆衛生である.
背景:
- 近所の社会経済的な地位 (SES) は,個々のSESから独立して心血管リスクに影響を与える可能性があります.
- 近所のSESが心筋梗塞 (MI) 患者のアウトカムに与える影響に関するデータは限られている.
研究 の 目的:
- 近所のSESと心筋梗塞患者のコホートにおける全因および心筋梗塞による死亡率との関連を調査する.
主な方法:
- イスラエル中部 (1992年−1993年) の1179人の心筋梗塞患者 (年齢=65歳未満) を2005年まで追跡調査した.
- 近所のSESは,国勢調査で得られたインデックスを用いて評価され,個々のSESデータ (教育,収入,雇用) が収集されました.
- 死亡率のデータは,生存率の推定値と調整された危険比率を使用して分析されました.
主要な成果:
- 恵まれない地域出身の患者では死亡率が高かった (13年生存率: 61% vs 74% vs 82%).
- 多変数調整後,近所のSESは全因死亡率 (HR 1.47 下位対上位三位) と心臓死亡率 (HR 1.63 下位対上位三位) の有意な予測因子であり続けました.
- 近所の状況と個々のSESは,それぞれ独立して死亡率と関連していました.
結論:
- 近所のSESは,MI後の長期生存の強力な予測因子です.
- 観察された関連性は,個々のSESと臨床的要因によって部分的に説明されますが,独立して持続します.
- これらの発見は,SESとMIの結果の間の複雑で多次元的な関係を強調しています.
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