Published online before print June 6, 2005, doi: 10.1161/CIRCULATIONAHA.104.496174
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(Circulation. 2005;111:3063-3070.)
© 2005 American Heart Association, Inc.
Epidemiology |
Long-Term Survival After Acute Myocardial Infarction Is Lower in More Deprived Neighborhoods
From the Departments of Environmental Health (C.T., J.S., S.M., H.S.) and Epidemiology (C.T., J.S., M.M.), Harvard School of Public Health, Boston, Mass; Beth Israel Deaconess Medical Center, Boston, Mass (M.M.); and University of Massachusetts Medical School, Worcester (R.G.).
Correspondence to Cathryn Tonne, Department of Environmental Health EER, Landmark Center, Room 415 W, PO Box 15677, 401 Park Dr, Boston, MA 02215. E-mail ctonne{at}hsph.harvard.edu
Received November 21, 2003; de novo received July 29, 2004; revision received January 31, 2005; accepted February 2, 2005.
Background— As part of the Worcester Heart Attack Study, a community-wide study examining changes over time in the incidence and long-term case-fatality rates of greater Worcester, Mass, residents hospitalized with confirmed acute myocardial infarction (AMI), we investigated the hypothesis that census tract–level socioeconomic position is an important predictor of survival after hospital discharge for AMI, after adjusting for demographic and clinical characteristics.
Methods and Results— Data were available for 3423 confirmed cases of AMI among metropolitan Worcester residents during the 4 study years of 1995, 1997, 1999, and 2001 who were followed up through the end of 2002. The mean age among patients was 69 years, and 58% were men. Using a multilevel Cox proportional hazards regression model, we estimated a 30% higher death rate after AMI for patients living in census tracts with the most residents living below the poverty line compared with patients living in the wealthiest census tracts (relative risk=1.30; 95% CI, 1.08 to 1.56). Similarly, patients living in census tracts with the highest proportion of residents with less than a high school education experienced a 47% higher death rate than patients living in census tracts with the lowest proportion of residents with less than a high school education (relative risk=1.47; 95% CI, 1.15 to 1.88).
Conclusions— Within a medium-sized urban area, there are important variations in survival after hospital discharge for AMI that are associated with socioeconomic position. These associations persist after adjustment for demographic and clinical characteristics. Reasons for these differences warrant further investigation.
Key Words: epidemiology • follow-up studies • myocardial infarction • survival
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