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Living Alone, Patient Sex and Mortality After Acute Myocardial Infarction

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Abstract

BACKGROUND

Psychosocial factors, including social support, affect outcomes of cardiovascular disease, but can be difficult to measure. Whether these factors have different effects on mortality post-acute myocardial infarction (AMI) in men and women is not clear.

OBJECTIVE

To examine the association between living alone, a proxy for social support, and mortality postdischarge AMI and to explore whether this association is modified by patient sex.

DESIGN

Historical cohort study.

PARTICIPANTS/SETTING

All patients discharged with a primary diagnosis of AMI in a major urban center during the 1998–1999 fiscal year.

MEASUREMENTS

Patients’ sociodemographic and clinical characteristics were obtained by standardized chart review and linked to vital statistics data through December 2001.

RESULTS

Of 880 patients, 164 (18.6%) were living alone at admission and they were significantly more likely to be older and female than those living with others. Living alone was independently associated with mortality [adjusted hazard ratio (HR) 1.6, 95% confidence interval (CI) 1.0–2.5], but interacted with patient sex. Men living alone had the highest mortality risk (adjusted HR 2.0, 95% CI 1.1–3.7), followed by women living alone (adjusted HR 1.2, 95% CI 0.7–2.2), men living with others (reference, HR 1.0), and women living with others (adjusted HR 0.9, 95% CI 0.5–1.5).

CONCLUSIONS

Living alone, an easily measured psychosocial factor, is associated with significantly increased longer-term mortality for men following AMI. Further prospective studies are needed to confirm the usefulness of living alone as a prognostic factor and to identify the potentially modifiable mechanisms underlying this increased risk.

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Acknowledgements

Financial support was provided by the Calgary Health Region and Institute of Health Economics. The funding organizations did not play a role in any of the following: design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. The authors wish to acknowledge Dr. David Hogan for his mentorship and helpful suggestions regarding the manuscript. This study is part of a collaborative network (involving Drs. Schmaltz, Ghali, Maxwell & King) with the gender and sex determinants of circulatory and respiratory diseases: interdisciplinary enhancement teams grant program, Canadian Institutes of Health Research Institute of Gender and Health and the Heart and Stroke Foundation of Canada. Dr. Maxwell is supported by the Canadian Institutes of Health Research (Institute of Aging) and the Alberta Heritage Foundation for Medical Research (AHFMR). Dr. Ghali and Dr. King also receive salary support from AHFMR. Dr. Ghali is also funded by a Canada Research Chair in Health Services Research. Dr. Maxwell had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Potential Financial Conflicts of Interest

None disclosed.

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Authors and Affiliations

  1. Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, Canada, T2N 4N1

    Heidi N. Schmaltz MDCM, FRCP(C), William A. Ghali MD, FRCP(C), MPH, Susan E. Jelinski PhD & Colleen J. Maxwell PhD

  2. Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada

    Danielle Southern MSc, William A. Ghali MD, FRCP(C), MPH, Kathryn M. King RN PhD & Colleen J. Maxwell PhD

  3. Institute of Health Economics, Edmonton, AB, Canada

    William A. Ghali MD, FRCP(C), MPH, Susan E. Jelinski PhD & Colleen J. Maxwell PhD

  4. Calgary Health Region, Calgary, AB, Canada

    Heidi N. Schmaltz MDCM, FRCP(C) & Gerry A. Parsons RN

  5. Faculty of Nursing, University of Calgary, Calgary, AB, Canada

    Kathryn M. King RN PhD

Authors
  1. Heidi N. Schmaltz MDCM, FRCP(C)
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  2. Danielle Southern MSc
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  3. William A. Ghali MD, FRCP(C), MPH
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  4. Susan E. Jelinski PhD
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  5. Gerry A. Parsons RN
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  6. Kathryn M. King RN PhD
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  7. Colleen J. Maxwell PhD
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Corresponding author

Correspondence to Colleen J. Maxwell PhD.

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Schmaltz, H.N., Southern, D., Ghali, W.A. et al. Living Alone, Patient Sex and Mortality After Acute Myocardial Infarction. J GEN INTERN MED 22, 572–578 (2007). https://doi.org/10.1007/s11606-007-0106-7

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  • DOI: https://doi.org/10.1007/s11606-007-0106-7

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