Does poorer self-rated health mediate the effect of Roma ethnicity on mortality in patients with coronary artery disease after coronaro-angiography?

OBJECTIVES: The aim of this prospective cohort study was to assess the effect of Roma ethnicity and self-rated health (SRH) on 9-year all-cause mortality in patients with coronary artery disease (CAD) after coronaro-angiography (CAG), and whether SRH mediates the effect of ethnicity. METHODS: 623 patients (103 Roma) were included. We obtained data from medical records and patients interviews. A Cox regression model adjusted for age, gender and education was used to analyze the effect of Roma ethnicity on mortality, as well as potential mediation by SRH. RESULTS: Roma ethnicity and poor SRH were predictors of increased mortality in patients with CAD, with hazard rates (95 % confidence intervals) 2.34 (1.24; 4.42) and 1.81 (1.02; 3.21). Adding education decreased the size of ethnic differences in mortality. The mediating effect of SRH on the association of ethnicity with mortality was not statistically significant; neither modified ethnicity the effect of SRH. CONCLUSIONS: Poor SRH does not mediate the higher mortality among Roma patients after CAG even though it indicates an increased risk of mortality. Roma patients with CAD have to be referred for special cardiological care earlier

Socioeconomic differences in psychosocial factors contributing to coronary heart disease:A review

Psychosocial factors have been shown to play an important role in the aetiology of coronary heart disease (CHD). A strong association between CHD and socioeconomic status (lower-level education, poor financial situation) has also been well established. Socioeconomic differences may thus also have an effect on psychosocial risk factors associated with CHD, and socioeconomic disadvantage may negatively affect the later prognosis and quality of life of cardiac patients. The aim of this study was to review the available evidence on socioeconomic differences in psychosocial factors which specifically contribute to CHD. A computer-aided search of the Medline and PsycINFO databases resulted in 301 articles in English published between 1994 and 2007. A comprehensive screening process identified 12 empirical studies which described the socioeconomic differences in CHD risk factors. A review of these studies showed that socioeconomic status (educational grade, occupation or income) was adversely associated with psychosocial factors linked to CHD. This association was evident in the case of hostility and depression. Available studies also showed a similar trend with respect to social support, perception of health and lack of optimism. Less consistent were the results related to anger and perceived stress levels. Socioeconomic disadvantage seems to be an important element influencing the psychosocial factors related to CHD, thus, a more comprehensive clarification of associations between these factors might be useful. More studies are needed, focused not only on well-known risk factors such as depression and hostility, but also on some lesser known psychosocial factors such as Type D and vital exhaustion and their role in CHD

Socioeconomic inequalities in quality of life and psychological outcomes among cardiac patients

The aim of this article is to explore socioeconomic inequalities in the psychological characteristics (psychological well-being, perceived mental health status) and perceived quality of life among cardiac patients. A structured interview was conducted with 362 patients (32% women, mean age 56 +/- 7.3 years) referred for coronary angiography. The GHQ-28 was used to measure psychological well-being, the SF-36 for perceived mental health status. Income and education indicated socioeconomic position. Logistic regressions were employed, adjusted for age, gender, functional status and severity of disease. Patients with low income or education had a higher probability of having poor psychological well-being compared to participants with high income or education (OR 5.5,CI 2.32-12.80; OR 3.1,CI 1.52-6.37 resp.), and were also more likely to have worse mental health status (OR2.9,CI 1.02-8.51;OR 4.8,CI 1.36-16.99 resp.), and low quality of life (OR 2.9,CI 1.02-8.51; OR 4.8,CI 1.36-16.99 resp.). Socioeconomic status was found to be negatively associated with the psychological outcomes and quality of life among cardiac patients. Socioeconomic inequalities should be taken into account when designing suitably-adapted interventions focusing on psychosocial factors among cardiac patients

Seven years' mortality in Roma and non-Roma patients after coronary angiography

BACKGROUND: Ethnicity is associated with differences in clinical course and outcomes of cardiac disease, often in association with a poorer socioeconomic position. The aim of this study was to compare the mortality after coronary angiography (CAG) of Roma and non-Roma patients matched for education and adjusted for gender and age. METHODS: In total, 816 patients were included in the study (167 Roma and 649 non-Roma). Data on socio-demographic background, disease history, use of drugs, coronary findings and type of treatment were obtained from medical records. Mortality was assessed up to seven years after CAG. Kaplan-Meier curves of mortality were plotted, and differences between the Roma and non-Roma patients were assessed using log-rank tests, matched for education and adjusted for gender and age. RESULTS: Mortality after CAG was significantly higher among Roma than non-Roma (log-rank test χ(2) = 7.59, P < 0.01) and remained so after matching for education and adjustment for gender, age, history of previous myocardial infarction and abnormal CAG (hazard ratio: 2.07, 95% confidence interval: 1.13-3.82). CONCLUSION: Mortality after CAG is higher among Roma, and this is not due to differences in age, gender or education. These results warrant further reconsideration of the management of Roma cardiac patients

Roma coronary heart disease patients have more medical risk factors and greater severity of coronary heart disease than non-Roma

<p>Coronary heart disease (CHD) is the most common cause of mortality and morbidity world-wide. Evidence on ethnic differences between the Roma and non-Roma regarding medical risk factors is scarce. The aim of this study was to assess differences in medical risk factors and the severity of CHD in Roma compared with non-Roma CHD patients, adjusted for gender, age and education.</p><p>Six hundred seventy four patients were included in this cross-sectional study (132 Roma, 542 non-Roma). Data on medical risk factors, symptoms, medication and severity of CHD were obtained from medical records. After matching Roma and non-Roma according to education, linear and logistic regression analyses with adjustments for gender and age were used.</p><p>Compared with non-Roma, Roma patients had significantly more risk factors and more severe types of CHD. They were treated less frequently with statins and beta-blockers, were more frequently left on pharmacotherapy and surgically revascularised. These differences remained after controlling for education, gender and age.</p><p>Roma CHD patients have a worse risk profile at entry of care and seem to be undertreated compared with non-Roma CHD patients.</p>