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.
Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Yariv
Y
Gerber
Susan A
SA
Weston
Jill M
JM
Killian
Terry M
TM
Therneau
Steven J
SJ
Jacobsen
Véronique L
VL
Roger
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