Article

Long-term survival after acute myocardial infarction is lower in more deprived neighborhoods.

Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA.
Circulation (impact factor: 14.74). 07/2005; 111(23):3063-70. DOI:10.1161/CIRCULATIONAHA.104.496174 pp.3063-70
Source: PubMed

ABSTRACT As part of the Worcester Heart Attack Study, a community-wide study examining changes over time in the incidence and long-term case-fatality rates of greater Worcester, Mass, residents hospitalized with confirmed acute myocardial infarction (AMI), we investigated the hypothesis that census tract-level socioeconomic position is an important predictor of survival after hospital discharge for AMI, after adjusting for demographic and clinical characteristics.
Data were available for 3423 confirmed cases of AMI among metropolitan Worcester residents during the 4 study years of 1995, 1997, 1999, and 2001 who were followed up through the end of 2002. The mean age among patients was 69 years, and 58% were men. Using a multilevel Cox proportional hazards regression model, we estimated a 30% higher death rate after AMI for patients living in census tracts with the most residents living below the poverty line compared with patients living in the wealthiest census tracts (relative risk=1.30; 95% CI, 1.08 to 1.56). Similarly, patients living in census tracts with the highest proportion of residents with less than a high school education experienced a 47% higher death rate than patients living in census tracts with the lowest proportion of residents with less than a high school education (relative risk=1.47; 95% CI, 1.15 to 1.88).
Within a medium-sized urban area, there are important variations in survival after hospital discharge for AMI that are associated with socioeconomic position. These associations persist after adjustment for demographic and clinical characteristics. Reasons for these differences warrant further investigation.

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Keywords

30% higher death rate
 
4 study years
 
47% higher death rate
 
acute myocardial infarction
 
census tract-level socioeconomic position
 
census tracts
 
clinical characteristics
 
community-wide study
 
greater Worcester
 
highest proportion
 
hospital discharge
 
long-term case-fatality rates
 
medium-sized urban area
 
metropolitan Worcester residents
 
multilevel Cox proportional hazards regression model
 
poverty line
 
school education
 
socioeconomic position
 
wealthiest census tracts
 
Worcester Heart Attack Study