Variation in Rates of Fatal Coronary Heart Disease by Neighborhood Socioeconomic Status: The Atherosclerosis Risk in Communities Surveillance (1992–2002)

Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, USA.
Annals of epidemiology (Impact Factor: 2.15). 04/2011; 21(8):580-8. DOI: 10.1016/j.annepidem.2011.03.004
Source: PubMed

ABSTRACT Racial and gender disparities in out-of-hospital deaths from coronary heart disease (CHD) have been well-documented, yet disparities by neighborhood socioeconomic status (nSES) have been less systematically studied in US population-based surveillance efforts.
We examined the association of nSES, classified into tertiles, with 3,743 out-of-hospital fatal CHD events, and a subset of 2,191 events classified as sudden, among persons aged 35 to 74 years in four US communities under surveillance by the Atherosclerosis Risk in Communities (ARIC). Poisson generalized linear mixed models generated age-, race- (white, black) and gender-specific standardized mortality rate ratios and 95% confidence intervals (RR, 95% CI).
Regardless of nSES measure used, inverse associations of nSES with all out-of-hospital fatal CHD and sudden fatal CHD were seen in all race-gender groups. The magnitude of these associations was larger among women than men. Further, among blacks, associations of low nSES (vs. high nSES) were stronger for sudden cardiac deaths (SCD) than for all out-of-hospital fatal CHD.
Low nSES was associated with an increased risk of out-of-hospital CHD death and SCD. Measures of the neighborhood context are useful tools in population-based surveillance efforts for documenting and monitoring socioeconomic disparities in mortality over time.

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    • "The decline of CHD mortality rates is heterogeneous in countries with higher CHD rates such as Finland, Ireland, and the United Kingdom [4]. CHD mortality rates vary according to social deprivation in Scotland [5], by migration status in England and Wales [6], and by neighborhood score regardless of gender and race in the US [7]. Additionally, an international comparison of six cohorts revealed that the decline in cardiovascular mortality differed according to socioeconomic status [8]. "
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    ABSTRACT: Disparities in the receipt of angiography and subsequent coronary revascularization have not been well-studied. We estimated prevalence ratios and 95% confidence intervals (PR, 95% CIs) for the association between neighborhood-level income (nINC) and receipt of angiography; and among those undergoing angiography, receipt of revascularization procedures, among 9941 hospitalized myocardial infarction patients under epidemiologic surveillance by the Atherosclerosis Risk in Communities Study (1993-2002). In analyses by tertile of nINC controlling for age, study community, gender, and year, compared with white patients from high nINC areas, black patients from low nINC (0.60, 0.54-0.66) and medium nINC (0.70, 0.60-0.78) areas, as well as white patients from low nINC areas (0.83, 0.75-0.91) were less likely to receive angiography, whereas black patients from high nINC and white patients from medium nINC areas were not. Associations were attenuated, but persisted, after we controlled for event severity, medical history, receipt of Medicaid, and hospital type. Compared with high nINC white patients, black patients were less likely, and white patients were as likely, to undergo cardiac revascularization, given receipt of an angiogram. Black and lower nINC patients were less likely to undergo angiography than were white patients and those from higher nINC areas. Among those receiving angiography, race, but not nINC, gradients persisted.
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