Differences in Social Hardships in Women and Men with Acute Myocardial Infarction: Impact on 30-Day Readmission

Faris Haddadin; Hassan Beydoun; Basera Sabharwal; Wojciech Rzechorzek; Mariam Khandaker; Alba Munoz Estrella; David Weininger; Bing Yue; Ricardo De La Villa; Jacqueline E Tamis-Holland

doi:10.1089/whr.2021.0150

Differences in Social Hardships in Women and Men with Acute Myocardial Infarction: Impact on 30-Day Readmission

Womens Health Rep (New Rochelle). 2022 Apr 12;3(1):437-442. doi: 10.1089/whr.2021.0150. eCollection 2022.

Affiliations

¹ Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA.
² Department of Cardiology, University of Arizona COM-Phoenix, Phoenix, Arizona, USA.
³ Department of Cardiology, Icahn School of Medicine at Mount Sinai Morningside, New York, New York, USA.
⁴ Department of Cardiovascular Medicine, Westchester Medical Center, New York Medical College, Valhalla, New York, USA.
⁵ Department of Cardiology, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA.
⁶ Department of Cardiology, Mount Sinai Medical Center, Miami, Florida, USA.

Abstract

Background: Studies have shown that women with acute myocardial infarction (AMI) have a higher prevalence of unfavorable social variables then men and have a worse outcome. Less is known regarding the impact of these social variables on 30-day readmission after AMI.

Materials and methods: We analyzed adult patients with AMI enrolled in a Quality Improvement Program intended to improve the peri-discharge care of patients with an AMI, and decrease all-cause 30-day unplanned readmissions. We compared clinical and social variables by gender. Multivariate logistic regression, with separate adjustment for clinical and for social variable, was used to measure adjusted odds for readmission by gender.

Results: Among 208 patients included in our project 68 (32.7%) were women. Only 30.9% of women were married or had domestic partner at the time of the interview and only 16.2% were employed. Nearly half of women (48.5%) needed help with medical care, and 39.7% of women did not speak English as their first language. These variables were significantly different by gender. Rates of 30-day readmissions were higher in women than men (22.1% vs. 7.8%, p = 0.024). After adjusting for clinical variables this difference by gender in 30-day readmissions remained significant (odds ratio [OR] 3.34 95% confidence interval [CI] 1.1-11.1, p = 0.049). However, when adjusting for social variables, this difference was no longer noted (OR 0.87 95% CI 0.27-2.78, p = 0.822).

Conclusion: Women with AMI are more likely than men to have unfavorable social factors that can impact recovery from AMI and women have a higher 30-day readmission rate. The higher 30-day readmissions in women appears to be influenced by these social factors. Health care interventions aimed at reducing 30-day readmission after AMI should focus on eliciting a detailed social history and providing aid for those requiring additional social support at home.

Keywords: Health Disparities; acute myocardial infarction; readmission; social hardships.