title: Socioeconomic disadvantage and acute coronary events: a spatiotemporal analysis.
abstract: BACKGROUND
  The associations between socioeconomic disadvantage and ischemic heart disease are not well understood. We explore the relationship between socioeconomic factors and acute coronary events using spatiotemporal analysis.
  
  
  METHODS
  We studied all deaths from acute myocardial infarction and hospital admissions for acute coronary syndrome and related revascularization procedures for the state of New South Wales, Australia, from 1996 through 2002. We used conditional autoregressive models to describe how characteristics of subjects' place of residence (socioeconomic disadvantage, proportion of the population of indigenous background, and metropolitan versus nonmetropolitan area) influenced admissions and mortality.
  
  
  RESULTS
  There were 32,534 deaths due to acute myocardial infarction and 129,045 admissions for acute coronary syndrome. We found a relationship between increasing socioeconomic disadvantage and mortality (unadjusted relative risk for highest quartile of disadvantage relative to lowest = 1.40; 95% confidence interval = 1.27-1.54) as well as admissions (1.41; 1.28-1.55). After accounting for admission rates, socioeconomic disadvantage was associated with lower rates of angiography (0.75; 0.63-0.88) and interventional angiography (0.70; 0.56-0.85). After adjusting for socioeconomic disadvantage, areas with higher proportions of the population identified as indigenous had higher rates of admission and mortality, while residency in the state capital was associated with higher admission rates and more interventional angiography. After accounting for admission rates, the association of socioeconomic disadvantage with mortality was reduced.
  
  
  CONCLUSIONS
  Socioeconomic disadvantage increases both the risk of acute coronary syndrome and related mortality. A contributing factor appears to be a reduced chance of receiving appropriate care. Regions with a higher proportion of indigenous residents show risk beyond the effects of general socioeconomic disadvantage, while residents of metropolitan communities had increased utilization of more recent interventions.
authors.affiliation: Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY 10029, USA. jbeard@nyam.org
authors.forename: John R
authors.initials: JR
authors.lastname: Beard
authors.forename: Arul
authors.initials: A
authors.lastname: Earnest
authors.forename: Geoff
authors.initials: G
authors.lastname: Morgan
authors.forename: Hsien
authors.initials: H
authors.lastname: Chan
authors.forename: Richard
authors.initials: R
authors.lastname: Summerhayes
authors.forename: Therese M
authors.initials: TM
authors.lastname: Dunn
authors.forename: Nola A
authors.initials: NA
authors.lastname: Tomaska
authors.forename: Louise
authors.initials: L
authors.lastname: Ryan
mesh_terms: D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality*; D009517:New South Wales / Q000453:epidemiology; D012044:Regression Analysis; D012307:Risk Factors; D012923:Social Class