Associations of socioeconomic status with length of hospital stay in a recent german myocardial infarction registry
H Schulze, B Sasko, S Steinbeiss, S Baum, F Schenk, N Pagonas, C Holmberg, O Ritter, D FuellerAbstract
Background/Introduction
Lower socioeconomic status (SES) is consistently associated with a higher incidence and mortality of acute myocardial infarction (AMI). Patients with lower SES experience worse outcomes following AMI, including higher rates of recurrent AMI, stroke and heart failure. Longer hospital stay is associated with more comorbidities, higher rates of complications such as cardiogenic shock and vascular complications, readmission for AMI and unplanned revascularization, need for intensive care, heart failure, and increased short-term and long-term mortality. It is unknown whether lower SES is associated with longer hospital stay following AMI.
Purpose
To evaluate whether SES is associated with length of hospital stay in total as well as length of stay on an intensive care unit or intermediate care unit in a recent German cohort of patients hospitalized for AMI and enrolled in a myocardial infarction registry.
Methods
We analyzed data of 802 patients admitted with an AMI between April 2019 and December 2024 with available information on the highest level of education and occupational qualification acheived which were used as indicators of SES. Only patients who were discharged alive from the hospital were included. Differences in days of hospital stay in total, days on an Intensive Care Unit or Intermediate Care Unit were analyzed. Statistical significance was tested with analysis of variance.
Results
Mean age of the cohort was 69.7 years and 70.8% were men. Regarding the level of education, 38.5% had a low, 43.0% had a medium, and 18.5% had a high level of education. Regarding occupational qualification, 7.5% had a low, 74.2% had a medium, and 18.3% had a high occupational qualification. Length of hospital stay was higher among patients with a low level of education (mean 8.1 days) compared to patients with a medium level of education (6.7 days) or high level of education (7.1 days) (P=0.007). Differences according to a low (8.5 days), medium (7.4 days), and high (6.8 days) occupational qualification were not statistically significant (P=0.14). Patients with a low occupational qualification had a higher mean length of stay on an Intermediate Care Unit (low occupational qualification: 2.1 days; medium: 1.7 days; high 1.5 days) (P=0.03), whereas there were no differences with regard to the level of education, and no differences in the length of stay on an Intensive Care Unit according to the occupational qualification or the level of education.
Conclusion(s)
Using the level of education and occupational qualification as indicators of SES, we show that a lower level of education is associated with longer hospital stay in total and lower occupational qualification is associated with longer length of stay on an Intermediate Care Unit following AMI, reflecting higher healthcare resource utilization and costs associated with lower SES in patients with AMI.