White-collar AMI patients had over 50% lower 2-year posthospital mortality than unemployed patients (HR 0.487), but difference lost significance after adjusting for treatments; unstable job status pre
Does occupational status impact clinical characteristics, treatments, and mortality in patients with acute myocardial infarction?
In patients with acute myocardial infarction in China, having a stable job is associated with a higher prevalence of baseline cardiovascular risk factors but a significantly better 2-year survival rate compared to farmers and the unemployed.
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Abstract Background Acute myocardial infarction (AMI) is one of the leading causes of mortality worldwide. Previous studies conducted in developed countries mainly demonstrated reverse relation between occupational status and cardiovascular mortality. However, in developing countries, the impact of occupational status on risk factors, clinical characteristics, in-hospital and long-term prognosis of patients with AMI remains largely unknown. Methods Based on data from CAMI (China Acute Myocardial Infarction) registry, patients diagnosed with AMI admitted from January 2013 to January 2016 were involved in the present study. Patients were divided into four groups (White-collar, Blue-collar, farmers and the unemployed) according to their occupational status to evaluate the impact of occupational classes on clinical characteristics, treatments, in-hospital and 2-year mortality after discharge. Results The study comprised 11318 AMI patients(88.1% men) with a mean (SD) age of 50.11 (6.96) years. Patients among White- and Blue-collar groups were more likely to have risk factors like overweight, smoking, hypertension, diabetes and dyslipidemia, whereas less serious clinical conditions and higher rates of reperfusion therapy. No significant in-hospital mortality differences were observed after fully controlling confounders. Regarding 2-year posthospital mortality, the risk was more than 50% lower in White-collar group than that in unemployed group (hazard ratio HR0.487; 95% confidence interval CI 0.257-0.924). However, after adjusting for clinical characteristics, hospital level and primary percutaneous coronary intervention (PPCI), the White-collar related protection was no longer significant (HR 0.540; 95% CI 0.283-1.032). The posthospital 2-year mortality remained significantly higher among patients with unstable job (including farmers and unemployed patients) even afteraccounting for potential confounding factors (HR 1.603; 95%CI 1.147 -2.242). Conclusion Patients with stable employment, including White- and Blue-collar workers, exhibited a significantly higher prevalence of cardiovascular disease risk factors while enjoying more favorable long-term prognoses compared to farmers and the unemployed. This trend was particularly pronounced among White-collar workers.Graphical Abstract
Zhu et al. (Sat,) reported a other. White-collar AMI patients had over 50% lower 2-year posthospital mortality than unemployed patients (HR 0.487), but difference lost significance after adjusting for treatments; unstable job status pre.