title: Neighborhood income, health insurance, and prehospital delay for myocardial infarction: the atherosclerosis risk in communities study.
abstract: BACKGROUND
  Outcomes following an acute myocardial infarction (AMI) are generally more favorable if prehospital delay time is minimized.
  
  
  METHODS
  We examined the association of neighborhood household income (nINC) and health insurance status with prehospital delay among a weighted sample of 9700 men and women with a validated, definite, or probable AMI in the Atherosclerosis Risk in Communities (ARIC) community surveillance study (1993-2002). Weighted multinomial regression with generalized estimation equations was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) and to account for the clustering of patients within census tracts.
  
  
  RESULTS
  Low nINC was associated with a higher odds of long vs short delay (OR, 1.46; 95% CI, 1.09-1.96) and medium vs short delay (OR, 1.43; 95% CI, 1.12-1.81) compared with high nINC in a model including age, sex, race, diabetes, hypertension, presence of chest pain, arrival at the hospital via emergency medical service, distance from residence to hospital, study community, and year of AMI event. Meanwhile, compared with patients with prepaid insurance or prepaid plus Medicare, patients with Medicaid were more likely to have a long vs short delay (OR, 1.87; 95% CI, 1.10-3.19) and a medium vs short delay (OR, 1.76; 95% CI, 1.13-2.74).
  
  
  CONCLUSIONS
  Both low nINC and being a Medicaid recipient are associated with longer prehospital delay. Reducing socioeconomic and insurance disparities in prehospital delay is critical because excess delay time may hinder effective care for AMI.
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, 137 E Franklin St, Ste 306, Chapel Hill, NC 27514, USA. randi_foraker@unc.edu
authors.forename: Randi E
authors.initials: RE
authors.lastname: Foraker
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Rose
authors.forename: Aileen P
authors.initials: AP
authors.lastname: McGinn
authors.forename: Chirayath M
authors.initials: CM
authors.lastname: Suchindran
authors.forename: David C
authors.initials: DC
authors.lastname: Goff
authors.forename: Eric A
authors.initials: EA
authors.lastname: Whitsel
authors.forename: Joy L
authors.initials: JL
authors.lastname: Wood
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Rosamond
mesh_terms: D005260:Female; D006760:Hospitalization; D006801:Humans; D007182:Income; D007348:Insurance, Health; D008297:Male; D006278:Medicare; D009203:Myocardial Infarction / Q000628:therapy*; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States