title: Race, Socioeconomic Status, and Life Expectancy After Acute Myocardial Infarction.
abstract: BACKGROUND
  Previous studies have been unable to disentangle the negative associations of black race and low socioeconomic status (SES) with long-term outcomes of patients after acute myocardial infarction (AMI). Such information could assist in efforts to address both racial and socioeconomic disparities.
  
  
  RESULTS
  We used data from the Cooperative Cardiovascular Project, a prospective cohort study of Medicare beneficiaries hospitalized with AMI with 17 years of follow-up, to evaluate the relationship between race, area-level SES (measured by zip code-level median household income), and life expectancy after AMI. Life expectancy was estimated by using Cox proportional hazards regression with extrapolation using exponential models. Of the 141 095 patients with AMI, 6.3% were black and 6.8% resided in low-SES areas; 26% of black patients lived in low-SES areas in comparison with 5.7% of white patients. Post-myocardial infarction life expectancy estimates were shorter for black patients than for white patients across all socioeconomic levels in patients ≤ 75 years of age. After adjustment for patient and treatment characteristics, the association between race and life expectancy persisted but was attenuated. Younger black patients (<68 years) had shorter life expectancies than white patients, whereas older black patients had longer life expectancies. The largest white-black gap in life expectancy occurred in patients residing in high- and medium-SES areas (P=0.02 interaction).
  
  
  CONCLUSIONS
  Black and white patients residing in low-SES areas have similar life expectancies after AMI, which are lower than those living in higher-SES areas. Racial disparities were most prominent among patients living in high-SES areas.
authors.affiliation: From Yale School of Medicine, New Haven, CT (E.M.B.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (E.M.B.); Department of Biostatistics, Yale School of Public Health, New Haven, CT (S.M.); Department of Biostatistics, Harvard School of Public Health, and Department of Health Care Policy, Harvard Medical School, Boston, MA (S.-L.T.N.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven CT (H.M.K.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Robert Wood Johnson Clinical Scholars Program, Department of Medicine (H.M.K.); and the Section of Health Policy and Administration, School of Public Health, Yale University School of Medicine, New Haven, CT (H.M.K.).
authors.forename: Emily M
authors.initials: EM
authors.lastname: Bucholz
authors.affiliation: From Yale School of Medicine, New Haven, CT (E.M.B.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (E.M.B.); Department of Biostatistics, Yale School of Public Health, New Haven, CT (S.M.); Department of Biostatistics, Harvard School of Public Health, and Department of Health Care Policy, Harvard Medical School, Boston, MA (S.-L.T.N.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven CT (H.M.K.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Robert Wood Johnson Clinical Scholars Program, Department of Medicine (H.M.K.); and the Section of Health Policy and Administration, School of Public Health, Yale University School of Medicine, New Haven, CT (H.M.K.).
authors.forename: Shuangge
authors.initials: S
authors.lastname: Ma
authors.affiliation: From Yale School of Medicine, New Haven, CT (E.M.B.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (E.M.B.); Department of Biostatistics, Yale School of Public Health, New Haven, CT (S.M.); Department of Biostatistics, Harvard School of Public Health, and Department of Health Care Policy, Harvard Medical School, Boston, MA (S.-L.T.N.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven CT (H.M.K.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Robert Wood Johnson Clinical Scholars Program, Department of Medicine (H.M.K.); and the Section of Health Policy and Administration, School of Public Health, Yale University School of Medicine, New Haven, CT (H.M.K.).
authors.forename: Sharon-Lise T
authors.initials: SL
authors.lastname: Normand
authors.affiliation: From Yale School of Medicine, New Haven, CT (E.M.B.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (E.M.B.); Department of Biostatistics, Yale School of Public Health, New Haven, CT (S.M.); Department of Biostatistics, Harvard School of Public Health, and Department of Health Care Policy, Harvard Medical School, Boston, MA (S.-L.T.N.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven CT (H.M.K.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Robert Wood Johnson Clinical Scholars Program, Department of Medicine (H.M.K.); and the Section of Health Policy and Administration, School of Public Health, Yale University School of Medicine, New Haven, CT (H.M.K.). harlan.krumholz@yale.edu.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008017:Life Expectancy; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality; D010343:Patient Admission / Q000706:statistics & numerical data; D011203:Poverty; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012494:Sampling Studies; D012923:Social Class; D012959:Socioeconomic Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American
keywords: follow-up studies; mortality; myocardial infarction; prognosis; survival