Association of marital/partner status with hospital readmission among young adults with acute myocardial infarction

• Published in: PloS one Vol. 19; no. 1; p. e0287949
• Main Authors: Zhu, Cenjing, Dreyer, Rachel P., Li, Fan, Spatz, Erica S., Caraballo, César, Mahajan, Shiwani, Raparelli, Valeria, Leifheit, Erica C., Lu, Yuan, Krumholz, Harlan M., Spertus, John A., D’Onofrio, Gail, Pilote, Louise, Lichtman, Judith H.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 26.01.2024; Public Library of Science (PLoS)
• Subjects: Adults; Age; Analysis; Cardiovascular disease; Care and treatment; Chronic obstructive pulmonary disease; Complications and side effects; Demographics; Demography; Diagnosis; Divorce; Education; Health aspects; Health insurance; Heart attack; Heart attacks; Hospital care; Hospitals; Husband and wife; Ischemia; Kinases; Marriage; Mediation; Medical records; Mental depression; Mortality; Myocardial infarction; Patients; Prevention; Psychological aspects; Secondary schools; Sensitivity analysis; Sex differences; Social aspects; Social support; Socioeconomic factors; Socioeconomics; Statistical models; Teenagers; Variables; Women; Young adults; Youth; United States; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0287949

Despite evidence supporting the benefits of marriage on cardiovascular health, the impact of marital/partner status on the long-term readmission of young acute myocardial infarction (AMI) survivors is less clear. We examined the association between marital/partner status and 1-year all-cause readmission and explored sex differences among young AMI survivors. Data were from the VIRGO study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients), which enrolled young adults aged 18-55 years with AMI (2008-2012). The primary end point was all-cause readmission within 1 year of hospital discharge, obtained from medical records and patient interviews and adjudicated by a physician panel. We performed Cox proportional hazards models with sequential adjustment for demographic, socioeconomic, clinical, and psychosocial factors. Sex-marital/partner status interaction was also tested. Of the 2,979 adults with AMI (2002 women [67.2%]; mean age 48 [interquartile range, 44-52] years), unpartnered individuals were more likely to experience all-cause readmissions compared with married/partnered individuals within the first year after hospital discharge (34.6% versus 27.2%, hazard ratio [HR] = 1.31; 95% confidence interval [CI], 1.15-1.49). The association attenuated but remained significant after adjustment for demographic and socioeconomic factors (adjusted HR, 1.16; 95% CI, 1.01-1.34), and it was not significant after further adjusting for clinical factors and psychosocial factors (adjusted HR, 1.10; 95%CI, 0.94-1.28). A sex-marital/partner status interaction was not significant (p = 0.69). Sensitivity analysis using data with multiple imputation and restricting outcomes to cardiac readmission yielded comparable results. In a cohort of young adults aged 18-55 years, unpartnered status was associated with 1.3-fold increased risk of all-cause readmission within 1 year of AMI discharge. Further adjustment for demographic, socioeconomic, clinical, and psychosocial factors attenuated the association, suggesting that these factors may explain disparities in readmission between married/partnered versus unpartnered young adults. Whereas young women experienced more readmission compared to similar-aged men, the association between marital/partner status and 1-year readmission did not vary by sex.