社会经济状况对北京市急性心肌梗死患者心血管疾病危险因素分布和临床治疗的影响

Effects of socioeconomic status on the distribution of cardiovascular risk factors and clinical treatments of patients with acute myocardial infarction in Beijing

目的评估社会经济状况对北京市急性心肌梗死患者心血管疾病危险因素分布和临床治疗的影响。方法数据来源于前瞻性、多中心、注册研究。包括2005年11月至2006年12月连续入选自北京市19家医院因患急性ST段抬高型心肌梗死并于24h之内到达上述医院且住院接受治疗的800名患者。主要社会经济指标包括：自述个人经济收入、受教育程度以及医疗保险情况。按照受教育程度，将患者分为社会经济状况较差和较好两组。分别比较两组患者的心血管疾病危险因素分布和住院期间临床治疗情况。结果社会经济状况较好的患者中糖尿病和高血脂症患者的比例明显高于社会经济状况较差的患者（P〈0．05，P〈0．01）。社会经济状况较差的患者中吸烟患者的比例较高（P〈0．05）。社会经济状况较差的患者接受冠脉造影和经皮腔内冠状动脉成形术（PTCA）的比例明显低于社会经济状况较好的患者。医疗保险与经济收入是决定进行PTCA的最重要的两个社会经济因素。结论与社会经济状况较羞的冠心病患者相比，社会经济状况较好的患者其危险因素中，高脂血症和糖尿病的比例较高，而吸烟率较低；社会经济状况较羞的患者接受介入性检查和治疗手段的比例较低。

Objective To evaluate the effects of socioeconomic status on the distribution of cardiovascular risk factors and clinical treatments of patients with acute myocardial infarction in Beijing. Methods In Beijing, a prospective, multi-center, registration study was carried out which including 800 patients who were consecutively hospitalized for ST-segment elevation acute myocardial infarction within 24 hours after event attack in 19 different hospitals in Beijing between November, 2005 and December, 2006. Indicators of socioeconomic status included self-reported personal income （ 〈 500, 500-2000, 〉 2000 RMB/ month）, educational attainment （≤ 12 and 〉 12 years） and status of medical insurance （yes/no）. According to categories of education, patients were categorized into two groups of lower socioeconomic status and higher socioeconomic status. Differences of cardiovascular risk factors and clinical treatments were compared across the two groups respectively. Results Proportion of diabetes and hyperlipidemia in patients with higher socioeconomic status was much higher than that of patients with lower socioeconomic status （ P 〈 0.05, P 〈 0.01 respectively）. Patients with lower socioeconomic status were more likely to be smokers （P〈 0.05）. The rates of receiving coronary angiography and PTCA were much lower in patients with lower socioeconomic status. Medical insurance and income were the most important two socioeconomic factors determining the use of PTCA. Conclusion Compared to patients with lower socioeconomic status, patients with higher socioeconomic status had higher rates of hyperlipidemia and diabetes but lower smoking rate among cardiovascular risk factors. The rates of receiving intervcntional therapies were much lower in patients with lower socioeconomic status.