Socioeconomic Assessment and Impact of Social Security on Outcome in Patients Admitted with Suspected Coronary Chest Pain in the City of Salta, Argentina
Low socioeconomic status is associated with increased mortality from coronary heart disease. We assessed total mortality, cardiac death, and sudden cardiac death (SCD) in relation to socioeconomic class and social security in 982 patients consecutively admitted with suspected coronary chest pain, living in the city of Salta, northern Argentina. Patients were divided into three socioeconomic classes based on monthly income, residential area, and insurance coverage. Five-year follow-up data were analyzed accordingly, applying univariate and multivariate analyses. At follow-up, 173 patients (17.6%) had died. In 92 patients (9.4%) death was defined as cardiac, of whom 59 patients (6.0%) were characterized as SCD. In the multivariate analysis, the hazard ratios (HRs) for all-cause and cardiac mortality in the highest as compared to the lowest socioeconomic class were 0.42 (95% confidence interval (CI), 0.22–0.80), , and 0.39 (95% CI, 0.15–0.99), , respectively. Comparing patients in the upper socioeconomic class to patients without healthcare coverage, HRs were 0.46 (95% CI, 0.23–0.94), , and 0.37 (95% CI, 0.14–1.01), , respectively. In conclusion, survival was mainly tied to socioeconomic inequalities in this population, and the impact of a social security program needs further attention. 1. Introduction In addition to the well-known risk factors for cardiovascular disease, such as hypertension, diabetes, cigarette smoking, hypercholesterolemia, obesity, and a sedentary lifestyle [1], socioeconomic status may also have an impact on prognosis [2]. As socioeconomic inequalities vary between countries and regions, they need to be accounted for in risk assessment within communities with marked social gradients. To our knowledge, socioeconomic inequalities and their associations with cardiovascular mortality have not been studied in Salta, northern Argentina. According to official data [3] 7.9% of the population in the Salta region is unemployed, but a wider definition than the one used would indicate an incidence of 29.3% (local data attached to the official data), and 60% are without a health security program (Table 1) [3]. Table 1: General demographic indicators in Argentinean and Salta populations [ 3]. The city of Salta has two large public hospitals, one for adults (405 beds) and one for obstetrics and pediatrics. They provide comprehensive care for patients in all medical and surgical specialties, but high-cost medical treatment is not widely available in the province of Salta. In the city of Salta there are also eleven private clinics with a total number
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