Neighborhood income and individual education: effect on survival after myocardial infarction.
OBJECTIVE
To evaluate the association of neighborhood-level income and individual-level education with post-myocardial infarction (MI) mortality in community patients.


METHODS
From November 1, 2002, through May 31, 2006, 705 (mean+/-SD age, 69+/-15 years; 44% women) residents of Olmsted County, MN, who experienced an MI meeting standardized criteria were prospectively enrolled and followed up. The neighborhood's median household income was estimated by census tract data; education was self-reported. Demographic and clinical variables were obtained from the medical records.


RESULTS
Living in a less affluent neighborhood and having a low educational level were both associated with older age and more comorbidity. During follow-up (median, 13 months), 155 patients died. Neighborhood income (hazard ratio [HR], 2.10; 95% confidence interval [CI], 1.42-3.12; for lowest [median, $34,205] vs highest [median, $60,652] tertile) and individual education (HR, 2.21; 95% CI, 1.47-3.32; for <12 vs >12 years) were independently associated with mortality risk. Adjustment for demographics and various post-MI prognostic indicators attenuated these estimates, yet excess risk persisted for low neighborhood income (HR, 1.62; 95% CI, 1.08-2.45). Modeled as a continuous variable, each $10,000 increase in annual income was associated with a 10% reduction in mortality risk (adjusted HR, 0.90; 95% CI, 0.82-0.99).


CONCLUSIONS
In this geographically defined cohort of patients with MI, low individual education and poor neighborhood income were associated with a worse clinical presentation. Poor neighborhood income was a powerful predictor of mortality even after controlling for a variety of potential confounding factors. These data confirm the socioeconomic disparities in health after MI.
Gerber
Yariv
Y
Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Weston
Susan A
SA
Killian
Jill M
JM
Therneau
Terry M
TM
Jacobsen
Steven J
SJ
Roger
Véronique L
VL
D000368:Aged; D015897:Comorbidity; D004522:Educational Status; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D012111:Residence Characteristics; D012307:Risk Factors; D012923:Social Class; D011795:Surveys and Questionnaires