Negative attitudes to transition in post-communist Albania and acute coronary syndrome

Abstract

Objective: The authors assessed the association of acute coronary syndrome (ACS) with attitudes to the socioeconomic aspects of rapid change in transitional Albania.

Design: A population-based case-control study conducted in Tirana, Albania, in 2003-2006 included 467 nonfatal ACS patients (370 men, 97 women; 88% response) and a population-sampled control group (469 men, 268 women; 69% response).

Main outcome measures: Reaction to transition was assessed as a composite score of 3 items capturing attitudes toward socioeconomic aspects of transition in Albania.

Results: Using logistic regression, there was a strong linear relationship of the attitude score with ACS. When categorized as negative, intermediate, or positive attitudes, the age- and sex-adjusted odds ratio (OR) for the negative versus positive categories was 3.0; 95% confidence interval (CI) = 2.1, 4.3; p for linear trend <.01, which persisted on adjustment for socioeconomic characteristics, psychosocial factors, and conventional coronary risk factors, OR = 4.4; 95% CI = 2.7, 7.2; p for linear trend <.01. The association appeared to be stronger in the more vulnerable, lower socioeconomic segment of Albanian society.

Conclusion: In a country moving rapidly from rigid Stalinism to a free market-oriented society, the authors found a strong association of negative attitudes toward transition with coronary health. The authors hypothesized that the stressor effect of inadequate coping with change in transitional Albania is a plausible mechanism linking a negative perception of transition with excess coronary risk.