Employment status as a predictor of adverse outcomes in patients with coronary artery disease

Background

Lack of employment is associated with a poorer prognosis when compared to employment in the general population. Whether this association is present in patients with coronary artery disease (CAD) and similarly extends to adverse cardiovascular outcomes in those with CAD remains unknown. Herein, we analyzed the association of employment status and adverse outcomes in patients with CAD.

Methods

Non-retired participants enrolled in the Emory Cardiovascular Biobank during the years 2003–2023 were divided into employed and non-employed cohorts and analyzed for the primary composite outcome of cardiovascular death or non-fatal myocardial infarction (MI) by competing-risk regression, while accounting for non-cardiovascular death. The secondary outcome of all-cause death was assessed by Cox regression. Sensitivity analyses were performed to explore for heterogeneity of effect.

Results

The study sample consisted of 2809 participants with a mean age of 57 years, 35 % women, and 27 % Black. During a median follow-up of 5.1 years, 406 (14 %) cardiovascular death or non-fatal MI events and 537 (19 %) all-cause death events occurred. After adjustment for demographics, educational attainment level (EAL), and traditional cardiovascular risk factors, non-employment was found to be a significant predictor of cardiovascular death or non-fatal MI (sHR 1.78, 95 % CI 1.41–2.19, P < 0.001) and all-cause death (HR 2.46, 95 % CI 2.02–2.99, P < 0.001), when compared to employed participants.

Conclusions

Non-employment is associated with adverse outcomes in non-retired individuals with CAD, independent of demographics, EAL, and traditional cardiovascular risk factors. Non-employment due to disability was associated with the highest risk of adverse cardiovascular outcomes, highlighting a particularly vulnerable subgroup.