High socio-economic deprivation increased 1-year mortality risk in patients with diabetes post-myocardial infarction compared to low deprivation (18.8% vs 17.8%; HR 1.05; 95% CI 1.01-1.10; p<0.001).
Cohort (n=729,722)
Yes
Does socio-economic deprivation increase mortality in patients with diabetes following acute myocardial infarction?
Socio-economic deprivation is associated with increased long-term mortality following AMI in patients with diabetes, although the deprivation-related inequality gap is smaller than in patients without diabetes.
Hazard Ratio: 1.05 (95% CI 1.01–1.1)
Absolute Event Rate: 18.8% vs 17.8%
p-value: p=< 0.001
BACKGROUND: People from areas of socio-economic deprivation have poorer outcomes following acute myocardial infarction (AMI). How deprivation influences the survival of people with diabetes mellitus (DM) post-AMI is not well described. METHODS: Using the Myocardial Ischaemia National Audit Project (MINAP) registry, with Office for National Statistics (ONS) mortality recording, 729,722 patients from England and Wales between 2005 and 2019 were included, 152,867 with DM and followed up to 31 July 2021. Patients were stratified into quintiles using the Index of Multiple Deprivation (IMD) score (Q1-most-deprived, Q5-least deprived), Cox regression models were fitted and adjusted mortality risk estimates were compared by IMD quintile and DM status. RESULTS: Thirty-day mortality risk between Q1 (most deprived) and Q5 (least deprived) was similar for patients with DM, but in patients without DM, risk was higher in the most deprived group (aHR: 1.05 (1.01-1.09), p < 0.001). Risk of 1-year (aHR: 1.05 (1.01-1.10), p < 0.001), 5-year (aHR: 1.14 (1.11-1.17), p < 0.001) and overall mortality (aHR: 1.14 (1.12-1.17), p < 0.001) was higher in Q1 compared to Q5 for patients with DM, but this increase was smaller than in patients without DM at 1 year (aHR: 1.12 (1.09-1.14), p < 0.001), 5 years (aHR: 1.18 (1.16-1.20), p < 0.001) and overall (aHR: 1.22 (1.20-1.23), p < 0.001). Adjusted 1-year mortality was higher in patients with DM than those without DM regardless of IMD quintile (e.g. DM vs. non-DM: Q1: 18.8% vs. 16.1%, Q5: 17.8% vs. 14.6%). CONCLUSION: Patients with DM from socio-economically deprived regions have a higher risk of mortality at 1 year, 5 years and overall, compared to least deprived patients with DM following AMI. However, the inequality gap was larger in the non-diabetic population, suggesting that current approaches to management in people with DM may mitigate some of the effect of deprivation on outcomes.
Weight et al. (Mon,) conducted a cohort in Acute myocardial infarction and diabetes mellitus (n=729,722). High socio-economic deprivation (IMD Q1) vs. Low socio-economic deprivation (IMD Q5) was evaluated on 1-year mortality (HR 1.05, 95% CI 1.01-1.10, p=< 0.001). High socio-economic deprivation increased 1-year mortality risk in patients with diabetes post-myocardial infarction compared to low deprivation (18.8% vs 17.8%; HR 1.05; 95% CI 1.01-1.10; p<0.001).