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Background <p>While Western studies often show an inverse association between occupational status and cardiovascular mortality, its impact on acute myocardial infarction (AMI) characteristics and prognosis in Eastern middle-income countries remains unclear.</p> Methods <p>Using data from the multi-center prospective China Acute Myocardial Infarction (CAMI) registry from January 2013 to January 2016, 11,318 admission AMI patients aged 18–60 years were stratified by occupation: white-collar (22.1%), blue-collar (23.4%), farmers (44.3%), and unemployed (10.1%). White- and blue-collar workers comprised the “stable employment” group; farmers and unemployed comprised “unstable employment.” We compared risk factors, treatments, and clinical outcomes. Multivariable Cox regression assessed occupational impacts on in-hospital and 2-year post-discharge all-cause mortality, progressively adjusting for demographics, self-reported risk histories and clinically measured parameters, treatments and hospital level.</p> Results <p>Stable employment groups (particularly white-collar patients) had higher baseline cardiovascular risks but less severe clinical presentation and higher reperfusion rates than unstable groups. No significant in-hospital mortality differences were observed after full adjustment. At 2-year follow-up, white-collar patients initially demonstrated 50% lower post-discharge mortality versus unemployed after demographic adjustment (HR 0.487; 95% CI 0.257–0.924). This association weakened with adjustment for risk histories/clinical characteristics (HR 0.506; 95% CI 0.266–0.964) and became non-significant after including treatment/hospital-level factors (HR 0.519; 95% CI 0.271–1.021). Neither blue-collar workers (fully adjusted HR 0.848; 95% CI 0.474–1.516) nor farmers (fully adjusted HR 1.164; 95% CI 0.702–1.931) showed significant mortality differences versus unemployed. Critically, unstable employment independently predicted higher 2-year post-discharge mortality after full adjustment (HR 1.639; 95% CI 1.169–2.298).</p> Conclusion <p>Stable employment (White- and Blue-collar) was associated with significantly higher cardiovascular risk factors but better long-term outcomes compared to farmers and the unemployed. This trend was particularly pronounced among White-collar workers.</p> Graphical Abstract <p></p>

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Occupational status and outcomes in acute myocardial infarction: a prospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月3日

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  • Yalin Zhu,
  • Jianyi Wang,
  • Qiujing Cai,
  • Yaxue Qiao,
  • Jingang Yang,
  • Haiyan Xu,
  • Shuhong Su,
  • Xiaojin Gao,
  • Wei Li,
  • Yuejin Yang

摘要

Background

While Western studies often show an inverse association between occupational status and cardiovascular mortality, its impact on acute myocardial infarction (AMI) characteristics and prognosis in Eastern middle-income countries remains unclear.

Methods

Using data from the multi-center prospective China Acute Myocardial Infarction (CAMI) registry from January 2013 to January 2016, 11,318 admission AMI patients aged 18–60 years were stratified by occupation: white-collar (22.1%), blue-collar (23.4%), farmers (44.3%), and unemployed (10.1%). White- and blue-collar workers comprised the “stable employment” group; farmers and unemployed comprised “unstable employment.” We compared risk factors, treatments, and clinical outcomes. Multivariable Cox regression assessed occupational impacts on in-hospital and 2-year post-discharge all-cause mortality, progressively adjusting for demographics, self-reported risk histories and clinically measured parameters, treatments and hospital level.

Results

Stable employment groups (particularly white-collar patients) had higher baseline cardiovascular risks but less severe clinical presentation and higher reperfusion rates than unstable groups. No significant in-hospital mortality differences were observed after full adjustment. At 2-year follow-up, white-collar patients initially demonstrated 50% lower post-discharge mortality versus unemployed after demographic adjustment (HR 0.487; 95% CI 0.257–0.924). This association weakened with adjustment for risk histories/clinical characteristics (HR 0.506; 95% CI 0.266–0.964) and became non-significant after including treatment/hospital-level factors (HR 0.519; 95% CI 0.271–1.021). Neither blue-collar workers (fully adjusted HR 0.848; 95% CI 0.474–1.516) nor farmers (fully adjusted HR 1.164; 95% CI 0.702–1.931) showed significant mortality differences versus unemployed. Critically, unstable employment independently predicted higher 2-year post-discharge mortality after full adjustment (HR 1.639; 95% CI 1.169–2.298).

Conclusion

Stable employment (White- and Blue-collar) was associated with significantly higher cardiovascular risk factors but better long-term outcomes compared to farmers and the unemployed. This trend was particularly pronounced among White-collar workers.

Graphical Abstract