Socioeconomic inequalities in anxiety among post-myocardial infarction patients in Pakistan - A cross-sectional study
1
Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
2
Department of Medicine, Aga Khan University, Karachi, Pakistan
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Anxiety is a common psychological sequela following myocardial infarction (MI), with reported prevalence ranging from 18% globally to 57% in Pakistan1. Low socioeconomic status (SES) is associated with poorer mental health outcomes, particularly in LMICs where healthcare costs are largely borne out-of-pocket2,3. Socioeconomic disadvantage may exacerbate anxiety among post-MI patients, which may adversely affect subsequent health outcomes4,5.
OBJECTIVE:
To assess the relationship between anxiety and SES in post-MI patients in Karachi, Pakistan.
METHODS:
A cross-sectional study was conducted among 230 adults aged ≥18 years with a first MI episode attending cardiology outpatient clinics at two tertiary care hospitals in Karachi, Pakistan. Participants were recruited using purposive sampling. SES was assessed using a composite index derived through exploratory factor analysis and categorized into quintiles. Anxiety was measured using a translated and content-validated version of the Beck Anxiety Inventory. Multivariable ordinal logistic regression was used to analyze the data using STATA 17.
RESULTS:
A sample of 230 post-MI patients were analyzed, including 65.7% males, with a mean age of 61.1±11.9 years. Nearly half reported mild to moderate anxiety. After adjustment, patients in the lowest SES quintile had significantly higher odds of worse anxiety compared with those in the highest quintile (OR=7.53; 95%CI:2.54–22.32). Female sex (OR=2.79; p=0.002), younger age (OR=0.95 per year; p=0.002), short time since MI (OR=0.98; p<0.001), hypertension (OR=4.72; p=0.002), and history of hospitalization (OR=3.15; p = 0.001) were also associated with higher anxiety levels. An interaction between hypertension and high cholesterol suggested a sub-additive effect on anxiety severity, with lower-than-expected odds when both conditions were present (OR=0.25; p=0.05).
CONCLUSIONS:
A clear socioeconomic gradient in anxiety severity was observed among post-MI patients, with a higher burden among those from lower socioeconomic strata. Integrating equity-oriented mental health screening into routine post-MI care may help reduce avoidable disparities in recovery and wellbeing.
Anxiety is a common psychological sequela following myocardial infarction (MI), with reported prevalence ranging from 18% globally to 57% in Pakistan1. Low socioeconomic status (SES) is associated with poorer mental health outcomes, particularly in LMICs where healthcare costs are largely borne out-of-pocket2,3. Socioeconomic disadvantage may exacerbate anxiety among post-MI patients, which may adversely affect subsequent health outcomes4,5.
OBJECTIVE:
To assess the relationship between anxiety and SES in post-MI patients in Karachi, Pakistan.
METHODS:
A cross-sectional study was conducted among 230 adults aged ≥18 years with a first MI episode attending cardiology outpatient clinics at two tertiary care hospitals in Karachi, Pakistan. Participants were recruited using purposive sampling. SES was assessed using a composite index derived through exploratory factor analysis and categorized into quintiles. Anxiety was measured using a translated and content-validated version of the Beck Anxiety Inventory. Multivariable ordinal logistic regression was used to analyze the data using STATA 17.
RESULTS:
A sample of 230 post-MI patients were analyzed, including 65.7% males, with a mean age of 61.1±11.9 years. Nearly half reported mild to moderate anxiety. After adjustment, patients in the lowest SES quintile had significantly higher odds of worse anxiety compared with those in the highest quintile (OR=7.53; 95%CI:2.54–22.32). Female sex (OR=2.79; p=0.002), younger age (OR=0.95 per year; p=0.002), short time since MI (OR=0.98; p<0.001), hypertension (OR=4.72; p=0.002), and history of hospitalization (OR=3.15; p = 0.001) were also associated with higher anxiety levels. An interaction between hypertension and high cholesterol suggested a sub-additive effect on anxiety severity, with lower-than-expected odds when both conditions were present (OR=0.25; p=0.05).
CONCLUSIONS:
A clear socioeconomic gradient in anxiety severity was observed among post-MI patients, with a higher burden among those from lower socioeconomic strata. Integrating equity-oriented mental health screening into routine post-MI care may help reduce avoidable disparities in recovery and wellbeing.
| eISSN: | 2654-1459 |
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