title: Neighborhood socioeconomic status and leisure-time physical activity after myocardial infarction: A longitudinal study.
abstract: BACKGROUND
  Area-level SES is independently associated with myocardial infarction (MI) prognosis, yet the mechanisms for this association remain speculative.
  
  
  OBJECTIVE
  Using a population-based cohort of MI patients, this study examined whether neighborhood SES predicts long-term trajectory of leisure-time physical activity (LTPA), an established prognostic factor.
  
  
  METHODS
  Patients aged ≤65 years (n=1410) admitted to hospital in central Israel with first MI in 1992-1993, were followed up through 2005. LTPA was reported on five successive occasions: at baseline, 3-6 months, 1-2 years, 5 years, and 10-13 years post-MI. Generalized estimating equations (GEEs) with ordinal outcome variable (LTPA classified as regular, irregular, or none) were used to determine the independent predictive role of neighborhood SES in LTPA trajectory post-MI. Analyses were conducted in 2010-2011.
  
  
  RESULTS
  Engagement in LTPA was poor, with point prevalence rates ranging from 33% to 37% for inactivity and from 19% to 27% for irregular activity throughout follow-up. The GEE-derived ORs (95% CIs) for decreased LTPA level in the lower and middle vs upper neighborhood SES tertiles were 2.49 (2.05, 3.02) and 1.60 (1.33, 1.92) after age and gender adjustment, and 1.55 (1.26, 1.90) and 1.23 (1.02, 1.49) after multivariable adjustment for individual SES measures, cardiovascular risk factors, MI characteristics, and disease-severity indices, respectively (p for trend <0.001).
  
  
  CONCLUSIONS
  Low neighborhood SES is a powerful predictor of poor LTPA uptake in MI survivors, even after extensive adjustment for individual SES and baseline clinical profile. LTPA may thus represent an intermediate mechanism between neighborhood SES and post-MI outcome, which provides prevention opportunities.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel. yarivg@post.tau.ac.il.
authors.forename: Yariv
authors.initials: Y
authors.lastname: Gerber
authors.forename: Vicki
authors.initials: V
authors.lastname: Myers
authors.forename: Uri
authors.initials: U
authors.lastname: Goldbourt
authors.forename: Yael
authors.initials: Y
authors.lastname: Benyamini
authors.forename: Yaacov
authors.initials: Y
authors.lastname: Drory
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007557:Israel; D007899:Leisure Activities; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009203:Myocardial Infarction / Q000503:physiopathology / Q000534:rehabilitation*; D011379:Prognosis; D011446:Prospective Studies; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012720:Severity of Illness Index; D012959:Socioeconomic Factors