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


RESULTS
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).


CONCLUSIONS
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.
Tonne
Cathryn
C
Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA. ctonne@hsph.harvard.edu
Schwartz
Joel
J
Mittleman
Murray
M
Melly
Steve
S
Suh
Helen
H
Goldberg
Robert
R
D000368:Aged; D000369:Aged, 80 and over; D001900:Boston; D004493:Education; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality*; D011204:Poverty Areas; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D015996:Survival Rate