Socioeconomic deprivation and prognostic outcomes in acute coronary syndrome: a meta-analysis using multidimensional socioeconomic status indices

• Main Authors: Anand, Vickram Vijay, Lee, Ethan Cheng Zhe, Yip, Han Chin, Goh, Rachel Sze Jen, Lin, Chaoxing, Kueh, Martin Tze Wah, Chong, Bryan, Kong, Gwyneth, Tay, Phoebe Wen Lin, Dalakoti, Mayank, Muthiah, Mark, Dimitriadis, Georgios K., Wang, Jiong-Wei, Mehta, Anurag, Foo, Roger, Tse, Gary, Figtree, Gemma A., Loh, Poay Huan, Chan, Mark Y., Mamas, Mamas A., Chew, Nicholas W. S.
• Other Authors: Lee Kong Chian School of Medicine (LKCMedicine)
• Format: Article
• Language: English
• Published: 2023
• Subjects: Science::Medicine; Acute Coronary Syndrome; Socioeconomic Status
• Online Access: https://hdl.handle.net/10356/172206
• Institution: Nanyang Technological University

Background: Low socioeconomic status (SES) is an important prognosticator amongst patients with acute coronary syndrome (ACS). This paper analysed the effects of SES on ACS outcomes. Methods: Medline and Embase were searched for articles reporting outcomes of ACS patients stratified by SES using a multidimensional index, comprising at least 2 of the following components: Income, Education and Employment. A comparative meta-analysis was conducted using random-effects models to estimate the risk ratio of all-cause mortality in low SES vs high SES populations, stratified according to geographical region, study year, follow-up duration and SES index. Results: A total of 29 studies comprising of 301,340 individuals were included, of whom 43.7% were classified as low SES. While patients of both SES groups had similar cardiovascular risk profiles, ACS patients of low SES had significantly higher risk of all-cause mortality (adjusted HR:1.19, 95%CI: 1.10–1.1.29, p < 0.001) compared to patients of high SES, with higher 1-year mortality (RR:1.08, 95%CI:1.03–1.13, p = 0.0057) but not 30-day mortality (RR:1.07, 95%CI:0.98–1.16, p = 0.1003). Despite having similar rates of ST-elevation myocardial infarction and non-ST-elevation ACS, individuals with low SES had lower rates of coronary revascularisation (RR:0.95, 95%CI:0.91–0.99, p = 0.0115) and had higher cerebrovascular accident risk (RR:1.25, 95%CI:1.01–1.55, p = 0.0469). Excess mortality risk was independent of region (p = 0.2636), study year (p = 0.7271) and duration of follow-up (p = 0.0604) but was dependent on the SES index used (p < 0.0001). Conclusion: Low SES is associated with increased mortality post-ACS, with suboptimal coronary revascularisation rates compared to those of high SES. Concerted efforts are needed to address the global ACS-related socioeconomic inequity. Registration and protocol: The current study was registered with PROSPERO, ID: CRD42022347987.