Résumé :
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[BDSP. Notice produite par INIST-CNRS I7R0xlqF. Diffusion soumise à autorisation]. We assessed whether the previously observed relationship between socioeconomic status (SES) and short-term mortality (pre-hospital mortality and 28-day case-fatality) after a first acute myocardial infarction (AMI) in persons75 years), and whether these relationships vary by sex. A nationwide register based cohort study was conducted. Between January 1st 1998 and December 31st 2007,76,351 first AMI patients were identified, of whom 60,498 (79.2%) were hospitalized. Logistic regression analyses were performed to measure SES differences in pre-hospital mortality after a first AMI and 28-day case-fatality after a first AMI hospitalization. All analyses were stratified by sex and age group (85), and adjusted for age, ethnic origin, marital status, and degree of urbanization. There was an inverse relation between SES and pre-hospital mortality in both sexes. There was also an inverse relation between SES and 28-day case-fatality after hospitalization, but only in men. Compared to elderly men with the highest SES, elderly men with the lowest SES had a higher pre-hospital mortality in both 75-84 year-olds (OR=1.26 ; 95% CI 1.09-1.47) and>=85 year-olds (OR=1.26 ; 1.00-1.58), and a higher 28-day case-fatality in both 75-84 year-olds (OR=1.26 ; 1.06-1.50) and>=85 year-olds (OR=1.36 ; 0.99-1.85). Compared to elderly women with the highest SES, elderly women with the lowest SES had a higher pre-hospital mortality in>=85 year-olds (OR=1.20 ; 0.99-1.46). To conclude, in men there are SES inequalities in both pre-hospital mortality and case-fatality after a first AMI, in women these SES inequalities are only shown in pre-hospital mortality. The inequalities persist in the elderly (>75 years of age). Clinicians and policymakers need to be more vigilant on the population with a low SES background, including the elderly.
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