Impact of Socioeconomic Disparities on Care and Outcomes of Cancer Patients Presenting With STEMI Between 2005 and 2019; a Nationwide British Study

Background

While current evidence suggests that the clinical outcomes of STEMI are worse among patients with cancer, it is unknown what role the patient's socioeconomic status plays.

Methods

A nationally linked cohort of STEMI patients (January 2005 to March 2019) was obtained from the MINAP and UK national Hospital Episode Statistics (HES APC) registries. Socioeconomic status was measured using Index of Multiple Deprivation (IMD) score divided into 5 quintiles (quintile 1: most affluent, quintile 5: most deprived). The impact of socioeconomic status on clinical outcomes was assessed using Cox-proportional-hazard and competing risk models.

Results

A total of 8459 STEMI admissions with cancer were identified between 01/01/2005 and 30/03/2019 with 1577 patients (18%) from the most deprived quintile. Patients from the most deprived quintile were more frequently female (quintile 5; 29% vs. quintile 1; 24%) and from ethnic minorities (quintile 5; 8% vs. quintile 1; 2%). They were less likely to receive PCI between 2005 and 2009. By 2018 PCI use was higher in quintile 5 (quintile 5; 84% vs. quintile 1;81%). The odds of death at1year was not higher in the most deprived patients. The risk of death was significantly higher at 5 years post-discharge (HR 1.27, 95% CI 1.10−1.47).

Conclusions

The socioeconomic status impact on outcomes of STEMI patients with cancer can be minimized by delivering equitable inpatient care, particularly PCI. While patients from the most deprived areas have similar odds of survival in the short-term, they have lower probability of survival in the long-term.