Association of Socioeconomic Disadvantage With Long-term Mortality After Myocardial Infarction

Abstract

IMPORTANCE Socioeconomic disadvantage is associated with poor health outcomes. However, whether socioeconomic factors are associated with post-myocardial infarction (MI) outcomes in younger patient populations is unknown.OBJECTIVE To evaluate the association of neighborhood-level socioeconomic disadvantage with long-term outcomes among patients who experienced an MI at a young age. DESIGN, SETTING, AND PARTICIPANTSThis cohort study analyzed patients in the Mass General Brigham YOUNG-MI Registry (at Brigham and Women's Hospital and Massachusetts General Hospital in Boston, Massachusetts) who experienced an MI at or before 50 years of age between January 1, 2000, and April 30, 2016. Each patient's home address was mapped to the Area Deprivation Index (ADI) to capture higher rates of socioeconomic disadvantage. The median follow-up duration was 11.3 years. The dates of analysis were May 1, 2020, to June 30, 2020.EXPOSURES Patients were assigned an ADI ranking according to their home address and then stratified into 3 groups (least disadvantaged group, middle group, and most disadvantaged group). MAIN OUTCOMES AND MEASURESThe outcomes of interest were all-cause and cardiovascular mortality. Cause of death was adjudicated from national registries and electronic medical records. Cox proportional hazards regression modeling was used to evaluate the association of ADI with all-cause and cardiovascular mortality. RESULTSThe cohort consisted of 2097 patients, of whom 2002 (95.5%) with an ADI ranking were included (median [interquartile range] age, 45 [42][43][44][45][46][47][48] years; 1607 male individuals [80.3%]). Patients in the most disadvantaged neighborhoods were more likely to be Black or Hispanic, have public insurance or no insurance, and have higher rates of traditional cardiovascular risk factors such as hypertension and diabetes. Among the 1964 patients who survived to hospital discharge, 74 (13.6%) in the most disadvantaged group compared with 88 (12.6%) in the middle group and 41 (5.7%) in the least disadvantaged group died. Even after adjusting for a comprehensive set of clinical covariates, higher neighborhood disadvantage was associated with a 32% higher all-cause mortality (hazard ratio, 1.32; 95% CI, 1.10-1.60; P = .004) and a 57% higher cardiovascular mortality (hazard ratio, 1.57; 95% CI, 1.17-2.10; P = .003).CONCLUSIONS AND RELEVANCE This study found that, among patients who experienced an MI at or before age 50 years, socioeconomic disadvantage was associated with higher all-cause and cardiovascular mortality even after adjusting for clinical comorbidities. These findings suggest that neighborhood and socioeconomic factors have an important role in long-term post-MI survival.

Impact of socioeconomic deprivation on evaluation for heart transplantation at an urban academic medical center

“…In our study, socioeconomic deprivation was not a significant barrier to listing for HT, as ADI and SES index were not found to be significant predictors after multivariate adjustment. This analysis utilized two metrics of socioeconomic deprivation, the ADI and SES index that have been previously demonstrated to be associated with poor cardiovascular health outcomes and incident heart failure risk 9–11 . A previous analysis of patients in UNOS bridged to transplant with LVAD found that patients had similar freedom from death or delisting on LVAD support independent of SES.…”

Relationship of Neighborhood Deprivation and Outcomes of a Comprehensive ST‐Segment–Elevation Myocardial Infarction Protocol

“… 10 The association of lower SEP with higher mortality after myocardial infarction, both in the short term and long term, has been extensively confirmed. 2 , 3 , 4 , 7 , 9 , 20 Despite decades of literature establishing this relationship, Davis et al previously showed that “there are no studies describing attempts to improve acute coronary heart disease” as it relates to cardiovascular health disparities. 21…”

Socio-economic and behavioral «portrait» of patients with myocardial infarction

“…В настоящем исследовании среди участников выраженной дифференциации по месту проживания в городской и сельской местности не получено. Регистровый анализ Brigham YOUNG-MI у пациентов с ИМ показал, что не столько само отношение места проживания к селу или городу, а именно социально-экономическое, этническое и религиозное благополучие района проживания являются детерминирующими факторами сердечно-сосудистого риска [18].…”