Socio economic crisis and mortality. Epidemiological testimony of the financial collapse of Argentina
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BioMed Central
Open Access
Original clinical investigation
Socio economic crisis and mortality. Epidemiological testimony of the financial collapse of Argentina Enrique P Gurfinkel*1, Gerardo E Bozovich2, Omar Dabbous3, Branco Mautner1 and Frederick Anderson3 Address: 1Cardiology and Cardiovascular Surgery Institute, Favaloro Foundation, Buenos Aires, Argentina, 2Instituto Argentino de Diagnóstico y Tratamiento, Buenos Aires, Argentina and 3Center for Outcomes Research, The University of Massachusetts Medical School, Worcester, MA. USA Email: Enrique P Gurfinkel* - [email protected]; Gerardo E Bozovich - [email protected]; Omar Dabbous - [email protected]; Branco Mautner - [email protected]; Frederick Anderson - [email protected] * Corresponding author
Published: 13 December 2005 Thrombosis Journal 2005, 3:22
doi:10.1186/1477-9560-3-22
Received: 18 October 2005 Accepted: 13 December 2005
This article is available from: http://www.thrombosisjournal.com/content/3/1/22 © 2005 Gurfinkel et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: Natural disasters, war, and terrorist attacks, have been linked to cardiac mortality. We sought to investigate whether a major financial crisis may impact on the medical management and outcomes of acute coronary syndromes. Methods: We analyzed the Argentine cohort of the international multicenter Global Registry of Acute Coronary Events (GRACE). The primary objective was to estimate if there was an association between the financial crisis period (April 1999 to December 2002) and in- hospital cardiovascular mortality, with the post-crisis period (January 2003 to September 2004) as the referent. Each period was defined according to the evolution of the Gross Domestic Product. We investigated the demographic characteristics, diagnostic and therapeutic procedures, morbidity and mortality. Results: We analyzed data from 3220 patients, 2246 (69.8%) patients in the crisis period and 974 (30.2%) in the post-crisis frame. The distribution of demographic and clinical baseline characteristics were not significantly different between both periods. During the crisis period the incidence of in-hospital myocardial infarction was higher (6.9% Vs 2.9%; p value < 0.0001), as well as congestive heart failure (16% Vs 11%; p value < 0.0001). Time to intervention with angioplasty was longer during the crisis, especially among public sites (median 190 min Vs 27 min). The incidence proportion of mortality during hospitalization was 6.2% Vs 5.1% after crisis. The crude OR for mortality was 1.2 (95% C.I. 0.87, 1.7). The odds for mortality were higher among private institutions {1.9 (95% C.I. 0.9, 3.8)} than for public centers {1.2 (95% C.I. 0.83, 1.79)}. We did not observe a significant interaction b
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