Effect of socioeconomic status on the occurrence and in-hospital outcome among patients with acute myocardial infarction: an observational analytic case-control study

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Shaban, Eman Khashaba, Ensaf Bassam, Ayman A. Abdelaziz, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4602022/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: The aim of this research was to assess the impact of socioeconomic status on the incidence and in-hospital results in patients experiencing acute myocardial infarction (AMI). Methods: A case control study was conducted on 100 patients who suffered from their first onset AMI, and age and sex matched 100 control group. The study methods for collecting data from the participants were history taking (demographic information, risk factors – such as smoking history, obesity, hypertension), laboratory investigation, analysis of blood pressure, echocardiography, BMI, and socioeconomic status (SES). SES was evaluated using Egyptian socioeconomic scale that includes 7 domains with a total score of 84. SES were classified into very low (65) levels depending on the quartiles of the score calculated. Results: It was observed that the occurrences and in-hospital outcomes, such as cardiogenic shock among AMI patients, were more common among the lower SES group than in the higher ones, with a statistically significant difference (p<0.05). Moreover, death was more common among the lower SES group than in the higher ones, with an increased risk of more than four times (OR = 4.8, CI; 1.5-16.6). Consequently, low and very low SES had more frequent in-hospital complications (41.1%) than middle & high SES (20.4 and 32.7%, respectively). Conclusion: These results show socioeconomic status is a significant aspect in shaping the overall health status of individuals, evaluated based on the presence of comorbid conditions measured during hospitalization for the first AMI. Similarly, in-hospital outcomes such as complications resulting from AMI are affected by patients’ socioeconomic statuses. Cardiac & Cardiovascular Systems Heart In-hospital outcome Myocardial infarction Socioeconomic status Figures Figure 1 Introduction Myocardial infarction (MI) stands as the principal contributor to both morbidity and mortality rates globally and is defined as myocardial cell death caused by prolonged ischemia ( 1 ). The most common underlying cause of MI is acute thrombus obstructing an atherosclerotic coronary artery ( 2 ). Many risk factors are associated with or linked to acute MI, including tobacco use, hyperlipidemia and family history ( 3 ). In the context of hyperlipidemia, heightened concentrations of total cholesterol, LDL cholesterol, or triglycerides are correlated with a heightened risk of developing coronary atherosclerosis and myocardial infarction. HDL levels less than 40 mg/dL also increase the risk ( 4 ). Co-morbidities such as diabetes mellitus and hypertension also increases the risk of MI ( 5 ). Male gender is another risk factor associated with acute MI. The MI incidence is higher in men than in women, particularly in young age ( 6 ). Furthermore, a familial history of early-onset coronary disease elevates the likelihood of an individual developing atherosclerosis and myocardial infarction ( 7 ) Similarly, smoking increase the risk of MI. The nicotine, which is present in smoke, decrease oxygen delivery to the heart and increases heart rate and blood pressure which in turn damage the cells that line coronary artery and other blood vessels ( 8 ). Additionally, heightened blood pressure causes arterial damage from the increased pressure exerted on their walls, leading to a compromised ability of the arteries to oxygenate different body regions. These damaged arteries may undergo hardening and narrowing due to the accumulation of fatty deposits ( 9 ). Evidence suggests that besides health and habitual-related factors, socioeconomic status (SES) can contribute to occurrences and in-hospital outcomes among AMI patients ( 10 ). Individuals with low (SES) are often residents of neighborhoods with similar SES profiles, and their disproportionately high prevalence of smoking, lack of physical activity, and obesity contribute to about one-third of the increased cardiovascular mortality observed in these communities. ( 11 ). Furthermore, inhabitants of low-SES neighborhoods are less likely to self-manage appropriately or adhere to treatment protocols ( 12 ). Literature suggests that lower SES over the life course is highly associated with an increased risk of chronic health outcomes, including MI ( 13 ). The relationships between mortality due to MI and lower SES is well-established ( 14 ). Prolonged exposure to socioeconomic disadvantage, as evidenced by low socioeconomic status (SES) of parents during one's childhood, reduced personal educational attainment, and diminished individual income, is associated with a heightened risk of myocardial infarction (MI) ( 15 ). Even though high-quality evidence supports the notion that low SES increases the risk of MI ( 16 ) and worsens hospital outcomes in MI patients( 17 ), there is a scarcity of literature that assesses explicitly SES association with MI occurrence and in-hospital outcomes in Egypt. Therefore, this study aimed to evaluate the association between socioeconomic status and the occurrence of acute myocardial infarction and in-hospital outcomes among AMI patients, such as hospital mortality and complications. Materials and methods Study setting and design. This case-control study of an observational and analytical nature was conducted in the Cardiology Department, specifically within the Coronary Care Unit (CCU) of the Mansoura Specialized Medical Hospital. It focused on patients experiencing their initial acute myocardial infarction, spanning from January 2015 to February 2016. Study Population The study population involved study cases suffering from first AMI, with most of them being married and 41 years and older. The control group was made up of healthy subjects (not suffering from AMI), with most of them working in Mansoura University Hospitals. Inclusion criteria New instances of acute myocardial infarction, initially admitted to the Coronary Care Unit (CCU) of the Cardiology Department, were incorporated into the study. Exclusion criteria Individuals presenting with historical myocardial infarction, unstable angina, non-ST segment elevation myocardial infarction, rheumatic valvular heart disease, congenital heart disease, malignancy, chronic liver disease, and chronic renal failure were excluded from the study. Data collection Data was collected through history taking, investigations, and taking medications data. First, history taking involved taking of demographic information, anthropometric measurements, risk factors (smoking history, obesity, hypertension, DM, dyslipidemia), and previous clinical and laboratory data. The study encompassed both clinical and laboratory data, which comprised blood pressure (BP) measurements and a range of biochemical tests. These tests included random blood sugar (RBS), serum creatinine levels, a fasting lipid profile, troponin-I, CPK, CK-MB, electrocardiography (ECG), and in-hospital outcomes. All patients were observed for entire duration of hospitalization that ranged from 4 days to 10 days. Body Mass Index (BMI) was determined using the formula: weight in kilograms divided by the square of height in meters (kg/m2). The classification of BMI was as follows: underweight was defined as a BMI of less than 18.5, normal weight was within the range of 18.5 to 24.9, overweight was categorized as a BMI of 25.0 to 29.9, and obesity was defined as a BMI of 30 or higher ( 18 ). Socioeconomic status was assessed using the Egyptian Socioeconomic Scale, which encompasses seven domains for a maximum score of 84. These domains include education and culture, occupation, family possessions, family characteristics, home sanitation, economic status, and access to healthcare. Based on the quartiles of the calculated scores, socioeconomic levels were categorized into very low (score 65) ( 19 ). Statistical analysis Data entry and statistical analyses were conducted utilizing the Statistical Package for the Social Sciences (SPSS) software, version 20.0, developed by SPSS Inc., located in Chicago, IL, USA. For the analysis, parametric data were presented as mean and standard deviation, whereas non-parametric data were detailed through median, minimum, and maximum values. A one-sample K-S test first tested the normality of data. In addition, the independent t-test was used to compare means for continuous parametric variables of the two groups. Moreover, the independent t-test was employed to compare the means of continuous parametric variables between the two groups. Additionally, the Mann-Whitney U test (z) was utilized to compare non-parametric continuous variables across the two groups. Qualitative data were summarized using frequencies and percentages, and the Pearson Chi-square tests were applied to assess the differences in categorical variables between the case and control groups. A P-value of less than 0.05 was deemed to indicate statistical significance. Results The age of nearly half of the participants ranged between 41 years to 60 years. Most of the cases and controls were from urban areas (59%; 63%, respectively) and married compared to single (97%, and 100%, respectively) (Table 1). There was no statistically significant difference between cases & control groups as regards socioeconomic categories. The mean score was slightly higher in control than cases (53.3 ± 14.7, and 51.2 ± 15.2, respectively) with no statistical significance difference (p > 0.05) (Table 2). The mean BMI (BMI) was found to be higher in the case group compared to the control group, demonstrating a statistically significant difference (p < 0.05). The frequency of heavy smoking was higher among cases than in the control group, with a statistically significant difference with about eleven times increased risk (p < 0.05, OR = 11.8). Also, the frequency of hypertension was higher among the case group than in the control group, with a statistically significant difference with thirteen times increased risk (p < 0.05, OR = 13.57). Moreover, the frequency of DM (Diabetes Mellitus) was higher among study case participants than among the control group, with a statistically significant difference of about three times increased risk (p < 0.05, OR = 2.69). Furthermore, the occurrence rate of dyslipidemia was elevated among the case subjects relative to the control group, indicating a statistically significant difference (p < 0.05) (Table 3). Additionally, the incidence of cardiogenic shock was notably higher in the lower socioeconomic status (SES) group compared to the higher SES group, demonstrating a statistically significant disparity (p < 0.05). This variation underscores the influence of SES on the occurrence of in-hospital complications. Moreover, mortality rates were significantly more significant within the lower SES group than in the higher SES group, presenting a fourfold increased risk (Odds Ratio (OR) = 4.8, Confidence Interval (CI); 1.5–16.6) respectively (Table 4). Additionally, low, and very low SES had more frequent in-hospital complications (41.1%) compared to middle and high SES. Death was more frequently found among low and very low SES groups (33.9%) compared to the middle (21.1%) and high SES groups (0%).) (Table 5). Also, the results indicate a statistically significant increased number of patients who received PCI treatment with a high socioeconomic score (71.4%) compared to low SES (27.5%) (p 0.05). There was a longer median time until seeking medical care among the low SES group compared to the higher one (p < 0.001) (Table 6). In comparing in-hospital outcomes against socioeconomic status, low and very low SES (socioeconomic status) individuals recorded frequent complications (41.1%) compared to middle and high SES (20.4, 32.7%; respectively). Similarly, death was more frequently found among the low and very low SES groups (33.9%) than in the middle (21.1%) and high SES groups (0%) (Fig. 1). Discussion The primary aim of the present study was to assess the impact of socioeconomic status on the incidence and in-hospital outcomes in patients experiencing their first acute myocardial infarction. Such outcomes include mortality (during hospital stay) from admission to discharge, morbidity in the form of arrhythmias, cardiogenic shock, mechanical complications, pulmonary edema, bleeding, stroke, and death. Also, the study evaluated the relationship between SES and the first MI occurrence. The study findings suggested that low SES is associated with MI occurrence. Previous research studies reported a significant relationship between SES and the occurrence of AMI ( 20 – 22 ). Low SES is generally considered a risk for developing MI. However, some individual studies reported that the prevalence of cardiovascular disease is more common among middle and high-SES groups compared to low-SES groups ( 23 , 24 ). The observed disparities underscore the necessity for additional high-quality research to accurately ascertain the relationship between socioeconomic status (SES) and myocardial infarction (MI) occurrence across various contexts. This need arises because the predominant body of existing literature, which suggests that MI is more frequent in higher socioeconomic classes, primarily consists of individual studies. By the results of the current study, previous studies reported that abdominal obesity, dyslipidemia, smoking, hypertension, and diabetes mellitus increase the risk of MI ( 25 , 26 ). Studies have indicated that the primary contributors to cardiovascular risk factors are rooted in disparities in health-related behaviors associated with social class. Behaviors, including smoking, excessive alcohol intake, a sedentary lifestyle, and poor dietary habits, are closely linked to cardiovascular diseases like hypertension and coronary artery disease. Notably, these behaviors are more prevalent among lower social classes ( 27 – 29 ). Evidence suggests that around 50% of both the relative and absolute differences in the risk of myocardial infarction (MI) related to socioeconomic status can be accounted for by four main behavioral and biological risk factors: hypertension, smoking, high cholesterol, and diabetes ( 30 , 31 ). In the present study, the occurrence of cardiogenic shock was observed to be higher among individuals from lower socioeconomic status (SES) groups compared to those from higher SES groups. Likewise, those belonging to low and shallow SES categories experienced complications more frequently than those in the middle and high SES brackets. Moreover, death was more common among the lower SES group than in the higher ones; these results align with several studies that have reported higher acute and long-term mortality and in-hospital complications after MI in the lowest SES groups. Poorer patients with MI are likely to receive less medical treatment during hospitalization and thus have poor outcomes( 32 ). Research reported increased mortality from MI in the lower socioeconomic class and among individuals without a social security program ( 33 , 34 ). Although there has been a decline in morbidity and mortality rates from cardiovascular diseases in many developed nations, these conditions remain a significant health challenge and the leading cause of death in numerous developing countries globally, including the Arab Republic of Egypt. Previous research studies reported that MI is the leading cause of morbidity and mortality in Egypt ( 35 , 36 ). The current study thoroughly assessed the association of SES with MI occurrent and in-hospital outcomes in Egypt and reported that people with low SES residing in Egypt are more prone to develop MI and may have poor outcomes compared to their counterparts with high SES. Literature suggests that higher SES families have a higher education level and more knowledge about the signs and symptoms of MI, and thus, timely management may result in better outcomes ( 37 , 38 ). A current study reported that older age was more common among low compared to high SES (86% and 58.3%, respectively). Previous studies presented several explanations for the age pattern in relative SEC inequalities. Firstly, premature MI disproportionately affects the most deprived groups ( 31 ). Additionally, the rise in population case-fatality rates with age could be attributed to diminished effectiveness of life-saving treatments, reduced hospitalization rates, less frequent utilization of diagnostic and therapeutic procedures, prolonged delays from the onset of symptoms to admission to the emergency room, and increased comorbidity among the elderly ( 39 ). On the contrary, high socioeconomic relative risks could be related and limited to premature MI events ( 40 , 41 ). Secondly, socioeconomic disparities in cardiovascular risk factors are more pronounced in younger individuals compared to older ones, particularly concerning smoking habits ( 42 , 43 ). The results of the current study showed a statistically significant increase in the number of patients who received PCI treatment with a high socioeconomic score compared to those with low SES. Streptokinase was more received by patients with lower SES than higher ones as it was mostly offered free or with governmental support. There was a longer median time until seeking medical care among the low SES group compared to the higher one. The findings of previous studies are consistent with the results of the current study and reported higher emergency department and in-hospital mortality rates among patients with lower socioeconomic status. Such results were because individuals with low SES were less likely to be treated aggressively (e.g., catheterization and PCI procedures), as they couldn't afford these procedures ( 44 ). Moreover, delays in hospital arrival and delays in seeking medical advice may be responsible for poor outcomes in MI patients with low SES ( 45 , 46 ). The swift provision of high-quality coronary care following acute coronary syndromes is crucial; however, individuals experiencing myocardial infarction (MI) often do not receive appropriate emergency care ( 47 , 48 ). The study had its limitations due to various factors. Foremost, the study population included patients hospitalized and treated for acute myocardial infarctions during a hospital stay only and did not include MI cases who died before hospital admission or were admitted to other hospitals in Mansoura. Additionally, adherence to treatment and any modifications to the treatment regimen remain undetermined, as no active follow-up was conducted post-hospital discharge. This is due to the study's focus solely on in-hospital outcomes. Given that this research is a single-center study, a multicenter study is recommended to broaden the scope and applicability of the findings. A multicenter study will include larger sample studies stressing the role of SES on premature MI. Conclusion The occurrence of AMI and in-hospital complications associated with AMI is broadly linked to low and very low socioeconomic status people. The association between socioeconomic status (SES) and the occurrence of in-hospital outcomes from acute myocardial infarction (AMI) can be attributed to various risk factors. The results indicate that socioeconomic status appears to be an important factor in shaping the overall health status of individuals, evaluated based on the presence of comorbid conditions measured during hospitalization for the first AMI. The findings indicated that the prevalence of heavy smoking, hypertension, diabetes mellitus (DM), dyslipidemia, and obesity was more significant in the case subjects compared to the control subjects, exhibiting a statistically significant difference. In addition, higher frequencies of severe & morbid obesity in the study case subjects than in the control group were noticed. Consequently, there was an increased number of patients who received PCI treatment with high socioeconomic scores compared to those with low SES. There was a long median time in seeking medical care among the low SES group (7hrs) compared to the higher one (5hrs). As a result, streptokinase therapy was more frequently received among the low SES group than the high-status group, with no statistically significant difference observed. Overall, there was a statistically significant difference in in-hospital complications regarding SES. It was concluded that low and very low— SES individuals had more frequent complications than middle and high— SES patients. For example, the incidences of cardiogenic shock were more common among the lower SES group than in the higher SES group. Likewise, the mortality rate was found to be higher among the lower socioeconomic status (SES) group compared to their counterparts. Furthermore, the incidence of dyslipidemia was significantly greater among the low and deficient SES groups than in the middle and high SES groups. Declarations Ethics Statement: This study was conducted by the ethical standards in the 1964 Declaration of Helsinki and its later amendments. The Medical Research Ethics Committee at [Mansoura University] reviewed and approved the research protocol. All participants provided informed consent before their inclusion in the study. The ethics approval code for this study is MS/758. Compliance with ethical standards Approval Number for Ethical Review: Studies with Human Subjects and the Process of Obtaining Informed Consent: Verbal informed consent was secured from all participants involved in the study, with a guarantee of confidentiality provided. The questionnaire was anonymous to gain participants' trust and confidence and encourage them to share information, code, test, and record the results. Conflict of Interest: On behalf of myself and all co-authors, we declare that there are no conflicts of interest related to this study. This encompasses any financial, personal, or professional connections that could be perceived as influencing the research. We affirm our commitment to transparency and ethical conduct in our work. 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(2023);389:889-98.doi:10.1056/NEJMoa2300468. Chandrashekhar Y, Alexander T, Mullasari A, Kumbhani DJ, Alam S, Alexanderson E, et al. Resource and Infrastructure-Appropriate Management of ST-Segment Elevation Myocardial Infarction in Low- and Middle-Income Countries. Circulation. (2020);141:2004-25.doi:10.1161/circulationaha.119.041297. Frank M, Sanders C, Berry BP. Evaluation and management of ST-segment elevation myocardial infarction in the emergency department. Emerg Med Pract. (2021);23:1-28. Landon BE, Hatfield LA, Bakx P, Banerjee A, Chen YC, Fu C, et al. Differences in Treatment Patterns and Outcomes of Acute Myocardial Infarction for Low- and High-Income Patients in 6 Countries. Jama. (2023);329:1088-97.doi:10.1001/jama.2023.1699. Tables Tables 1 to 6 are available in the Supplementary Files section Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4602022","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":316097978,"identity":"f8f9d3dc-bdb4-4c32-a7e6-63cb49cd6ec6","order_by":0,"name":"Eman E. Shaban","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABA0lEQVRIiWNgGAWjYDCCAxAqgUECSH6osAGSjI0HiNbCOONMGkhLA/FamHlbDiMLYgd8tw8f3fBzR10e/+zmZw9nNpy3W9t+GGhLjU00Li2S59LSbvaeOVwsceeYucHHHbeTt51JBGo5lpbbgEOLwRkesxu8bQcSG24kmEnOPHM72QzIPsDYcBiPFv5vN/+21SXOv5H+TZq37Vyy2fmHhLTwsN3mbWNO3HAjxwyo5YCd2Q0CtkieYTO7Ldt2OHHjnTNlkjPOJCeY3QDakoDHL3xnmJ/dfAt02Lzb7dskPlTY2ZudT3/44EONDU4tGCARrDKBWOUgYE+K4lEwCkbBKBgZAABHX3Gokf+t7wAAAABJRU5ErkJggg==","orcid":"","institution":"MOH - QCHP","correspondingAuthor":true,"prefix":"","firstName":"Eman","middleName":"E.","lastName":"Shaban","suffix":""},{"id":316098233,"identity":"92e88b59-ba46-4200-8e0d-390e5812f289","order_by":1,"name":"Eman Khashaba","email":"","orcid":"","institution":"Mansoura University Hospitals","correspondingAuthor":false,"prefix":"","firstName":"Eman","middleName":"","lastName":"Khashaba","suffix":""},{"id":316098979,"identity":"3f748ce9-00d8-40b2-b035-9370b2c0ebb0","order_by":2,"name":"Ensaf Bassam","email":"","orcid":"","institution":"Mansoura University Hospitals","correspondingAuthor":false,"prefix":"","firstName":"Ensaf","middleName":"","lastName":"Bassam","suffix":""},{"id":316098980,"identity":"5cf1c81e-b1f8-4cef-a4ac-e2db5d5adc69","order_by":3,"name":"Ayman A. Abdelaziz","email":"","orcid":"","institution":"Mansoura University Hospitals","correspondingAuthor":false,"prefix":"","firstName":"Ayman","middleName":"A.","lastName":"Abdelaziz","suffix":""},{"id":316098232,"identity":"6a9f538a-c90c-4cf3-bfdb-e99bb10e91c7","order_by":4,"name":"Hany A. Zaki","email":"","orcid":"","institution":"Hamad Medical Corporation","correspondingAuthor":false,"prefix":"","firstName":"Hany","middleName":"A.","lastName":"Zaki","suffix":""}],"badges":[],"createdAt":"2024-06-18 21:02:37","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":true,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4602022/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4602022/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":59515877,"identity":"9576ccc7-4120-44af-a338-f782d0d70f22","added_by":"auto","created_at":"2024-07-02 17:34:48","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":45306,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"Picture1.png","url":"https://assets-eu.researchsquare.com/files/rs-4602022/v1/28d9683b23bbddfbe7f33421.png"},{"id":59515892,"identity":"2fd35b99-d207-40c9-9e2d-d73be5bf42f4","added_by":"auto","created_at":"2024-07-02 17:34:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":479959,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4602022/v1/7ff65848-204f-47ad-b43f-91ba2c839a39.pdf"},{"id":59515876,"identity":"03f6a6cc-ce38-4bf6-a58d-bef33c3dbe8d","added_by":"auto","created_at":"2024-07-02 17:34:48","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":239686,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4602022/v1/27f80afe54e102434f513b82.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eEffect of socioeconomic status on the occurrence and in-hospital outcome among patients with acute myocardial infarction: an observational analytic case-control study\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMyocardial infarction (MI) stands as the principal contributor to both morbidity and mortality rates globally and is defined as myocardial cell death caused by prolonged ischemia (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The most common underlying cause of MI is acute thrombus obstructing an atherosclerotic coronary artery (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Many risk factors are associated with or linked to acute MI, including tobacco use, hyperlipidemia and family history (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In the context of hyperlipidemia, heightened concentrations of total cholesterol, LDL cholesterol, or triglycerides are correlated with a heightened risk of developing coronary atherosclerosis and myocardial infarction. HDL levels less than 40 mg/dL also increase the risk (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Co-morbidities such as diabetes mellitus and hypertension also increases the risk of MI (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Male gender is another risk factor associated with acute MI. The MI incidence is higher in men than in women, particularly in young age (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Furthermore, a familial history of early-onset coronary disease elevates the likelihood of an individual developing atherosclerosis and myocardial infarction (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) Similarly, smoking increase the risk of MI. The nicotine, which is present in smoke, decrease oxygen delivery to the heart and increases heart rate and blood pressure which in turn damage the cells that line coronary artery and other blood vessels (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Additionally, heightened blood pressure causes arterial damage from the increased pressure exerted on their walls, leading to a compromised ability of the arteries to oxygenate different body regions. These damaged arteries may undergo hardening and narrowing due to the accumulation of fatty deposits (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEvidence suggests that besides health and habitual-related factors, socioeconomic status (SES) can contribute to occurrences and in-hospital outcomes among AMI patients (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Individuals with low (SES) are often residents of neighborhoods with similar SES profiles, and their disproportionately high prevalence of smoking, lack of physical activity, and obesity contribute to about one-third of the increased cardiovascular mortality observed in these communities. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Furthermore, inhabitants of low-SES neighborhoods are less likely to self-manage appropriately or adhere to treatment protocols (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Literature suggests that lower SES over the life course is highly associated with an increased risk of chronic health outcomes, including MI (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The relationships between mortality due to MI and lower SES is well-established (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Prolonged exposure to socioeconomic disadvantage, as evidenced by low socioeconomic status (SES) of parents during one's childhood, reduced personal educational attainment, and diminished individual income, is associated with a heightened risk of myocardial infarction (MI) (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEven though high-quality evidence supports the notion that low SES increases the risk of MI (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) and worsens hospital outcomes in MI patients(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), there is a scarcity of literature that assesses explicitly SES association with MI occurrence and in-hospital outcomes in Egypt. Therefore, this study aimed to evaluate the association between socioeconomic status and the occurrence of acute myocardial infarction and in-hospital outcomes among AMI patients, such as hospital mortality and complications.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e \u003cb\u003eStudy setting and design.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis case-control study of an observational and analytical nature was conducted in the Cardiology Department, specifically within the Coronary Care Unit (CCU) of the Mansoura Specialized Medical Hospital. It focused on patients experiencing their initial acute myocardial infarction, spanning from January 2015 to February 2016.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Population\u003c/h2\u003e \u003cp\u003eThe study population involved study cases suffering from first AMI, with most of them being married and 41 years and older. The control group was made up of healthy subjects (not suffering from AMI), with most of them working in Mansoura University Hospitals.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eInclusion criteria\u003c/h2\u003e \u003cp\u003eNew instances of acute myocardial infarction, initially admitted to the Coronary Care Unit (CCU) of the Cardiology Department, were incorporated into the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eExclusion criteria\u003c/h2\u003e \u003cp\u003eIndividuals presenting with historical myocardial infarction, unstable angina, non-ST segment elevation myocardial infarction, rheumatic valvular heart disease, congenital heart disease, malignancy, chronic liver disease, and chronic renal failure were excluded from the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eData was collected through history taking, investigations, and taking medications data. First, history taking involved taking of demographic information, anthropometric measurements, risk factors (smoking history, obesity, hypertension, DM, dyslipidemia), and previous clinical and laboratory data. The study encompassed both clinical and laboratory data, which comprised blood pressure (BP) measurements and a range of biochemical tests. These tests included random blood sugar (RBS), serum creatinine levels, a fasting lipid profile, troponin-I, CPK, CK-MB, electrocardiography (ECG), and in-hospital outcomes. All patients were observed for entire duration of hospitalization that ranged from 4 days to 10 days. Body Mass Index (BMI) was determined using the formula: weight in kilograms divided by the square of height in meters (kg/m2). The classification of BMI was as follows: underweight was defined as a BMI of less than 18.5, normal weight was within the range of 18.5 to 24.9, overweight was categorized as a BMI of 25.0 to 29.9, and obesity was defined as a BMI of 30 or higher (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Socioeconomic status was assessed using the Egyptian Socioeconomic Scale, which encompasses seven domains for a maximum score of 84. These domains include education and culture, occupation, family possessions, family characteristics, home sanitation, economic status, and access to healthcare. Based on the quartiles of the calculated scores, socioeconomic levels were categorized into very low (score\u0026thinsp;\u0026lt;\u0026thinsp;40), low (score 40-56.9), middle (score 57-64.9), and high (score\u0026thinsp;\u0026gt;\u0026thinsp;65) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData entry and statistical analyses were conducted utilizing the Statistical Package for the Social Sciences (SPSS) software, version 20.0, developed by SPSS Inc., located in Chicago, IL, USA. For the analysis, parametric data were presented as mean and standard deviation, whereas non-parametric data were detailed through median, minimum, and maximum values. A one-sample K-S test first tested the normality of data. In addition, the independent t-test was used to compare means for continuous parametric variables of the two groups. Moreover, the independent t-test was employed to compare the means of continuous parametric variables between the two groups. Additionally, the Mann-Whitney U test (z) was utilized to compare non-parametric continuous variables across the two groups. Qualitative data were summarized using frequencies and percentages, and the Pearson Chi-square tests were applied to assess the differences in categorical variables between the case and control groups. A P-value of less than 0.05 was deemed to indicate statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe age of nearly half of the participants ranged between 41 years to 60 years. Most of the cases and controls were from urban areas (59%; 63%, respectively) and married compared to single (97%, and 100%, respectively) (Table\u0026nbsp;1).\u003c/p\u003e \u003cp\u003eThere was no statistically significant difference between cases \u0026amp; control groups as regards socioeconomic categories. The mean score was slightly higher in control than cases (53.3\u0026thinsp;\u0026plusmn;\u0026thinsp;14.7, and 51.2\u0026thinsp;\u0026plusmn;\u0026thinsp;15.2, respectively) with no statistical significance difference (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;2).\u003c/p\u003e \u003cp\u003eThe mean BMI (BMI) was found to be higher in the case group compared to the control group, demonstrating a statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The frequency of heavy smoking was higher among cases than in the control group, with a statistically significant difference with about eleven times increased risk (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, OR\u0026thinsp;=\u0026thinsp;11.8). Also, the frequency of hypertension was higher among the case group than in the control group, with a statistically significant difference with thirteen times increased risk (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, OR\u0026thinsp;=\u0026thinsp;13.57). Moreover, the frequency of DM (Diabetes Mellitus) was higher among study case participants than among the control group, with a statistically significant difference of about three times increased risk (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, OR\u0026thinsp;=\u0026thinsp;2.69). Furthermore, the occurrence rate of dyslipidemia was elevated among the case subjects relative to the control group, indicating a statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;3).\u003c/p\u003e \u003cp\u003eAdditionally, the incidence of cardiogenic shock was notably higher in the lower socioeconomic status (SES) group compared to the higher SES group, demonstrating a statistically significant disparity (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This variation underscores the influence of SES on the occurrence of in-hospital complications. Moreover, mortality rates were significantly more significant within the lower SES group than in the higher SES group, presenting a fourfold increased risk (Odds Ratio (OR)\u0026thinsp;=\u0026thinsp;4.8, Confidence Interval (CI); 1.5\u0026ndash;16.6) respectively (Table\u0026nbsp;4).\u003c/p\u003e \u003cp\u003eAdditionally, low, and very low SES had more frequent in-hospital complications (41.1%) compared to middle and high SES. Death was more frequently found among low and very low SES groups (33.9%) compared to the middle (21.1%) and high SES groups (0%).) (Table\u0026nbsp;5).\u003c/p\u003e \u003cp\u003eAlso, the results indicate a statistically significant increased number of patients who received PCI treatment with a high socioeconomic score (71.4%) compared to low SES (27.5%) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Streptokinase therapy was more frequently received among the low SES group than the high SES group, with no statistically significant difference (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). There was a longer median time until seeking medical care among the low SES group compared to the higher one (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;6).\u003c/p\u003e \u003cp\u003eIn comparing in-hospital outcomes against socioeconomic status, low and very low SES (socioeconomic status) individuals recorded frequent complications (41.1%) compared to middle and high SES (20.4, 32.7%; respectively). Similarly, death was more frequently found among the low and very low SES groups (33.9%) than in the middle (21.1%) and high SES groups (0%) (Fig.\u0026nbsp;1).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe primary aim of the present study was to assess the impact of socioeconomic status on the incidence and in-hospital outcomes in patients experiencing their first acute myocardial infarction. Such outcomes include mortality (during hospital stay) from admission to discharge, morbidity in the form of arrhythmias, cardiogenic shock, mechanical complications, pulmonary edema, bleeding, stroke, and death. Also, the study evaluated the relationship between SES and the first MI occurrence.\u003c/p\u003e \u003cp\u003eThe study findings suggested that low SES is associated with MI occurrence. Previous research studies reported a significant relationship between SES and the occurrence of AMI (\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Low SES is generally considered a risk for developing MI. However, some individual studies reported that the prevalence of cardiovascular disease is more common among middle and high-SES groups compared to low-SES groups (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The observed disparities underscore the necessity for additional high-quality research to accurately ascertain the relationship between socioeconomic status (SES) and myocardial infarction (MI) occurrence across various contexts. This need arises because the predominant body of existing literature, which suggests that MI is more frequent in higher socioeconomic classes, primarily consists of individual studies.\u003c/p\u003e \u003cp\u003eBy the results of the current study, previous studies reported that abdominal obesity, dyslipidemia, smoking, hypertension, and diabetes mellitus increase the risk of MI (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Studies have indicated that the primary contributors to cardiovascular risk factors are rooted in disparities in health-related behaviors associated with social class. Behaviors, including smoking, excessive alcohol intake, a sedentary lifestyle, and poor dietary habits, are closely linked to cardiovascular diseases like hypertension and coronary artery disease. Notably, these behaviors are more prevalent among lower social classes (\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Evidence suggests that around 50% of both the relative and absolute differences in the risk of myocardial infarction (MI) related to socioeconomic status can be accounted for by four main behavioral and biological risk factors: hypertension, smoking, high cholesterol, and diabetes (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the present study, the occurrence of cardiogenic shock was observed to be higher among individuals from lower socioeconomic status (SES) groups compared to those from higher SES groups. Likewise, those belonging to low and shallow SES categories experienced complications more frequently than those in the middle and high SES brackets. Moreover, death was more common among the lower SES group than in the higher ones; these results align with several studies that have reported higher acute and long-term mortality and in-hospital complications after MI in the lowest SES groups. Poorer patients with MI are likely to receive less medical treatment during hospitalization and thus have poor outcomes(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Research reported increased mortality from MI in the lower socioeconomic class and among individuals without a social security program (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough there has been a decline in morbidity and mortality rates from cardiovascular diseases in many developed nations, these conditions remain a significant health challenge and the leading cause of death in numerous developing countries globally, including the Arab Republic of Egypt. Previous research studies reported that MI is the leading cause of morbidity and mortality in Egypt (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). The current study thoroughly assessed the association of SES with MI occurrent and in-hospital outcomes in Egypt and reported that people with low SES residing in Egypt are more prone to develop MI and may have poor outcomes compared to their counterparts with high SES. Literature suggests that higher SES families have a higher education level and more knowledge about the signs and symptoms of MI, and thus, timely management may result in better outcomes (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA current study reported that older age was more common among low compared to high SES (86% and 58.3%, respectively). Previous studies presented several explanations for the age pattern in relative SEC inequalities. Firstly, premature MI disproportionately affects the most deprived groups (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdditionally, the rise in population case-fatality rates with age could be attributed to diminished effectiveness of life-saving treatments, reduced hospitalization rates, less frequent utilization of diagnostic and therapeutic procedures, prolonged delays from the onset of symptoms to admission to the emergency room, and increased comorbidity among the elderly (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). On the contrary, high socioeconomic relative risks could be related and limited to premature MI events (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSecondly, socioeconomic disparities in cardiovascular risk factors are more pronounced in younger individuals compared to older ones, particularly concerning smoking habits (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe results of the current study showed a statistically significant increase in the number of patients who received PCI treatment with a high socioeconomic score compared to those with low SES. Streptokinase was more received by patients with lower SES than higher ones as it was mostly offered free or with governmental support. There was a longer median time until seeking medical care among the low SES group compared to the higher one. The findings of previous studies are consistent with the results of the current study and reported higher emergency department and in-hospital mortality rates among patients with lower socioeconomic status. Such results were because individuals with low SES were less likely to be treated aggressively (e.g., catheterization and PCI procedures), as they couldn't afford these procedures (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). Moreover, delays in hospital arrival and delays in seeking medical advice may be responsible for poor outcomes in MI patients with low SES (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). The swift provision of high-quality coronary care following acute coronary syndromes is crucial; however, individuals experiencing myocardial infarction (MI) often do not receive appropriate emergency care (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe study had its limitations due to various factors. Foremost, the study population included patients hospitalized and treated for acute myocardial infarctions during a hospital stay only and did not include MI cases who died before hospital admission or were admitted to other hospitals in Mansoura. Additionally, adherence to treatment and any modifications to the treatment regimen remain undetermined, as no active follow-up was conducted post-hospital discharge. This is due to the study's focus solely on in-hospital outcomes. Given that this research is a single-center study, a multicenter study is recommended to broaden the scope and applicability of the findings. A multicenter study will include larger sample studies stressing the role of SES on premature MI.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe occurrence of AMI and in-hospital complications associated with AMI is broadly linked to low and very low socioeconomic status people. The association between socioeconomic status (SES) and the occurrence of in-hospital outcomes from acute myocardial infarction (AMI) can be attributed to various risk factors. The results indicate that socioeconomic status appears to be an important factor in shaping the overall health status of individuals, evaluated based on the presence of comorbid conditions measured during hospitalization for the first AMI. The findings indicated that the prevalence of heavy smoking, hypertension, diabetes mellitus (DM), dyslipidemia, and obesity was more significant in the case subjects compared to the control subjects, exhibiting a statistically significant difference. In addition, higher frequencies of severe \u0026amp; morbid obesity in the study case subjects than in the control group were noticed. Consequently, there was an increased number of patients who received PCI treatment with high socioeconomic scores compared to those with low SES.\u003c/p\u003e \u003cp\u003eThere was a long median time in seeking medical care among the low SES group (7hrs) compared to the higher one (5hrs). As a result, streptokinase therapy was more frequently received among the low SES group than the high-status group, with no statistically significant difference observed. Overall, there was a statistically significant difference in in-hospital complications regarding SES. It was concluded that low and very low\u0026mdash; SES individuals had more frequent complications than middle and high\u0026mdash; SES patients. For example, the incidences of cardiogenic shock were more common among the lower SES group than in the higher SES group. Likewise, the mortality rate was found to be higher among the lower socioeconomic status (SES) group compared to their counterparts. Furthermore, the incidence of dyslipidemia was significantly greater among the low and deficient SES groups than in the middle and high SES groups.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Statement:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThis study was conducted by the ethical standards in the 1964 Declaration of Helsinki and its later amendments. The Medical Research Ethics Committee at [Mansoura University] reviewed and approved the research protocol. All participants provided informed consent before their inclusion in the study. The ethics approval code for this study is MS/758.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompliance with ethical standards\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eApproval Number for Ethical Review:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudies with Human Subjects and the Process of Obtaining Informed Consent:\u003c/strong\u003e Verbal informed consent was secured from all participants involved in the study, with a guarantee of confidentiality provided.\u0026nbsp;The questionnaire was anonymous to gain participants' trust and confidence and encourage them to share information, code, test, and record the results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOn behalf of myself and all co-authors, we declare that there are no conflicts of interest related to this study. This encompasses any financial, personal, or professional connections that could be perceived as influencing the research. We affirm our commitment to transparency and ethical conduct in our work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Hany A. Zaki is employed by Hamad Medical Corporation, (Emergency Department), Qatar. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eKaier TE, Alaour B, Marber M. Cardiac troponin and defining myocardial infarction. Cardiovasc Res. (2021);117:2203-15.doi:10.1093/cvr/cvaa331.\u003c/li\u003e\n \u003cli\u003eMurphy A, Goldberg S. Mechanical Complications of Myocardial Infarction. Am J Med. 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Relationship of Neighborhood Deprivation and Outcomes of a Comprehensive ST-Segment-Elevation Myocardial Infarction Protocol. J Am Heart Assoc. (2021);10:e024540.doi:10.1161/jaha.121.024540.\u003c/li\u003e\n \u003cli\u003eMathew A, Hong Y, Yogasundaram H, Nagendran J, Punnoose E, Ashraf SM, et al. Sex and Medium-term Outcomes of ST-Segment Elevation Myocardial Infarction in Kerala, India: A Propensity Score-Matched Analysis. CJC Open. (2021);3:S71-s80.doi:10.1016/j.cjco.2021.09.023.\u003c/li\u003e\n \u003cli\u003eElbadawi A, Elgendy IY, Mahmoud K, Barakat AF, Mentias A, Mohamed AH, et al. Temporal Trends and Outcomes of Mechanical Complications in Patients With Acute Myocardial Infarction. JACC Cardiovasc Interv. (2019);12:1825-36.doi:10.1016/j.jcin.2019.04.039.\u003c/li\u003e\n \u003cli\u003eAl-Atta A, Zaidan M, Abdalwahab A, Asswad AG, Egred M, Zaman A, et al. Mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock. Rev Cardiovasc Med. 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(2020);21:1016-21.doi:10.1016/j.carrev.2019.12.026.\u003c/li\u003e\n \u003cli\u003eBiscaglia S, Guiducci V, Escaned J, Moreno R, Lanzilotti V, Santarelli A, et al. Complete or Culprit-Only PCI in Older Patients with Myocardial Infarction. N Engl J Med. (2023);389:889-98.doi:10.1056/NEJMoa2300468.\u003c/li\u003e\n \u003cli\u003eChandrashekhar Y, Alexander T, Mullasari A, Kumbhani DJ, Alam S, Alexanderson E, et al. Resource and Infrastructure-Appropriate Management of ST-Segment Elevation Myocardial Infarction in Low- and Middle-Income Countries. Circulation. (2020);141:2004-25.doi:10.1161/circulationaha.119.041297.\u003c/li\u003e\n \u003cli\u003eFrank M, Sanders C, Berry BP. Evaluation and management of ST-segment elevation myocardial infarction in the emergency department. Emerg Med Pract. (2021);23:1-28.\u003c/li\u003e\n \u003cli\u003eLandon BE, Hatfield LA, Bakx P, Banerjee A, Chen YC, Fu C, et al. Differences in Treatment Patterns and Outcomes of Acute Myocardial Infarction for Low- and High-Income Patients in 6 Countries. Jama. (2023);329:1088-97.doi:10.1001/jama.2023.1699.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 6 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Mansoura University Hospital","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Heart, In-hospital outcome, Myocardial infarction, Socioeconomic status","lastPublishedDoi":"10.21203/rs.3.rs-4602022/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4602022/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eThe aim of this research was to assess the impact of socioeconomic status on the incidence and in-hospital results in patients experiencing acute myocardial infarction (AMI).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA case control study was conducted on\u003cstrong\u003e \u003c/strong\u003e100 patients who suffered from their first onset AMI, and age and sex matched 100 control group. The study methods for collecting data from the participants were history taking (demographic information, risk factors – such as smoking history, obesity, hypertension), laboratory investigation, analysis of blood pressure, echocardiography, BMI, and socioeconomic status (SES). SES was evaluated using Egyptian socioeconomic scale that includes 7 domains with a total score of 84. SES were classified into very low (\u0026lt;40), low (40-56.9), middle (57-64.9), and high (\u0026gt;65) levels depending on the quartiles of the score calculated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eIt was observed that the occurrences and in-hospital outcomes, such as cardiogenic shock among AMI patients, were more common among the lower SES group than in the higher ones, with a statistically significant difference (p\u0026lt;0.05). Moreover, death was more common among the lower SES group than in the higher ones, with an increased risk of more than four times (OR = 4.8, CI; 1.5-16.6). Consequently, low and very low SES had more frequent in-hospital complications (41.1%) than middle \u0026amp; high SES (20.4 and 32.7%, respectively).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThese results show socioeconomic status is a significant aspect in shaping the overall health status of individuals, evaluated based on the presence of comorbid conditions measured during hospitalization for the first AMI. Similarly, in-hospital outcomes such as complications resulting from AMI are affected by patients’ socioeconomic statuses.\u003c/p\u003e","manuscriptTitle":"Effect of socioeconomic status on the occurrence and in-hospital outcome among patients with acute myocardial infarction: an observational analytic case-control study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-02 17:34:43","doi":"10.21203/rs.3.rs-4602022/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"94ab4a51-c0e8-4239-bdbd-a072bcb06ef3","owner":[],"postedDate":"July 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":33427770,"name":"Cardiac \u0026 Cardiovascular Systems"}],"tags":[],"updatedAt":"2024-07-02T17:34:43+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-02 17:34:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4602022","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4602022","identity":"rs-4602022","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}