Neighborhood Income and Individual Education: Effect on Survival After Myocardial Infarction

Abstract

OBJECTIVE-To evaluate the association of neighborhood-level income and individual-level education with post-myocardial infarction (MI) mortality in community patients. 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. PATIENTS AND METHODS-FromRESULTS-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,).CONCLUSION-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.Measures of social position have long been associated with post-myocardial infarction (MI) risk. 1,2 However, much of this complex interaction has yet to be elucidated. Socioeconomic status (SES) is a multidimensional construct comprising various factors acting at different levels 3-5 such that both individual-level and area-level measures could affect cardiovascular health through complementary mechanisms. 4,[6][7][8] In view of this concept, a "double jeopardy" (ie, a multidimensional vulnerability related to SES) theory was formulated but never formally tested. 9,10 Indeed, most previous studies These limitations are important because failing to control for key clinical factors leaves substantial potential for residual confounding and thus inconclusive results. Therefore, both the internal and external validity of these results can be challenged, and their applicability to the community is uncertain. 22,23Our study was undertaken to address these knowledge gaps by examining the association between primary SES indicators and post-MI mortality in patients from a geographically defined population. Specifically, we evaluated the prognostic importance of individual education and neighborhood-based income in defining risk after MI. , 2002, and May 31, 2...

Health Disparities: A Primer for Public Health Social Workers

“…Although disparities in care have persisted for many years, the magnitude of the disparities decreased between 1979 and 2004, which is likely due to declines in risk factors, such as tobacco use, and to the increase in protective factors such as exercise and weight control (Brown, Ross, Lopez, Thornton, & Kiros, 2008), income (Gerber et al, 2008), and a usual source of care (Dark & Ezenkwele, 2007;Edelman et al, 2008).…”

Tendencia en la sobrevida de pacientes hospitalizados por infarto agudo de miocardio según nivel socioeconómico: Chile, 2002-2012

“…Chile ha presentado igual tendencia: la tasa de mortalidad por enfermedad coronaria se redujo 24% entre 1998 y 2007 3 y la letalidad por infarto agudo de miocardio (IAM) también ha disminuido 4 . No obstante, se observan inequidades en salud en estos pacientes que desfavorecen a los más pobres 3,[5][6][7][8][9] .…”

“…Muchos son los factores que determinan el mayor riesgo de enfermar y morir por enfermedad coronaria en personas de bajo nivel socioeconó-mico 7,[9][10][11] . Hay desigualdad en el acceso a tratamientos, tanto en la fase aguda como alejada [12][13][14] , como también mayor prevalencia de factores de riesgo 15,16 .…”

“…Hay desigualdad en el acceso a tratamientos, tanto en la fase aguda como alejada [12][13][14] , como también mayor prevalencia de factores de riesgo 15,16 . En un contexto más amplio, también las condiciones estructurales -urbanización de grandes ciudades, calidad del barrio, tráfico o polución ambiental− aumentan la incidencia de eventos coronarios y determinan un peor pronóstico en estos pacientes 7,[17][18][19][20] .…”

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“…Diversos estudios demuestran que existe un gradiente inverso entre posición socioeconómica y morbimortalidad cardiovascular [2][3][4] , situación que se repite en los pacientes post infarto agudo de miocardio (IAM) [5][6][7][8][9] . Esta relación en parte se explica por la mayor carga de factores de riesgo cardiovascular que presentan los grupos más vulnerables [10][11][12] , lo cual ha sido confirmado en la última Encuesta Nacional de Salud Chilena de 2010 13 .…”