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

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. 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. 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). 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.