This Article Full Text Full Text (PDF) All Versions of this Article: 111/23/3063    most recent CIRCULATIONAHA.104.496174v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tonne, C. Articles by Goldberg, R. Search for Related Content PubMed PubMed Citation Articles by Tonne, C. Articles by Goldberg, R. Pubmed/NCBI databases Medline Plus Health Information Heart Attack Related Collections Health policy and outcome research Acute myocardial infarction Epidemiology Related Article

(Circulation. 2005;111:3063-3070.)
© 2005 American Heart Association, Inc.

Epidemiology

Long-Term Survival After Acute Myocardial Infarction Is Lower in More Deprived Neighborhoods

Cathryn Tonne, MPH; Joel Schwartz, PhD; Murray Mittleman, MD, DrPH; Steve Melly, MS; Helen Suh, ScD; Robert Goldberg, PhD

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

Related Article:

Persistent Social Patterning of Cardiovascular Risk: Rethinking the Familiar

Ana V. Diez Roux
Circulation 2005 111: 3020-3021. [Full Text]

This article has been cited by other articles:

				H. M. Krumholz Outcomes Research: Generating Evidence for Best Practice and Policies Circulation, July 15, 2008; 118(3): 309 - 318. [Full Text] [PDF]

				M. Riva, L. Gauvin, and T. A Barnett Toward the next generation of research into small area effects on health: a synthesis of multilevel investigations published since July 1998 J. Epidemiol. Community Health, October 1, 2007; 61(10): 853 - 861. [Abstract] [Full Text] [PDF]

				A. M. Davis, L. M. Vinci, T. M. Okwuosa, A. R. Chase, and E. S. Huang Cardiovascular Health Disparities: A Systematic Review of Health Care Interventions Med Care Res Rev, October 1, 2007; 64(5_suppl): 29S - 100S. [Abstract] [PDF]

				B. Chaix, M. Rosvall, and J. Merlo Assessment of the magnitude of geographical variations and socioeconomic contextual effects on ischaemic heart disease mortality: a multilevel survival analysis of a large Swedish cohort J. Epidemiol. Community Health, April 1, 2007; 61(4): 349 - 355. [Abstract] [Full Text] [PDF]

				R. Saracci Survival-related biases survive well Int. J. Epidemiol., February 1, 2007; 36(1): 244 - 246. [Full Text] [PDF]

				H. M. Krumholz and F. A. Masoudi The Year in Epidemiology, Health Services Research, and Outcomes Research J. Am. Coll. Cardiol., November 7, 2006; 48(9): 1886 - 1895. [Full Text] [PDF]

				M. H. Shishehbor, D. Litaker, C. E. Pothier, and M. S. Lauer Association of Socioeconomic Status With Functional Capacity, Heart Rate Recovery, and All-Cause Mortality JAMA, February 15, 2006; 295(7): 784 - 792. [Abstract] [Full Text] [PDF]

				R. F. Redberg Gender, Race, and Cardiac Care: Why the Differences? J. Am. Coll. Cardiol., November 15, 2005; 46(10): 1852 - 1854. [Full Text] [PDF]

				Social Status and Cardiovascular Disease Journal Watch Psychiatry, August 3, 2005; 2005(803): 3 - 3. [Full Text]

				A. V. Diez Roux Persistent Social Patterning of Cardiovascular Risk: Rethinking the Familiar Circulation, June 14, 2005; 111(23): 3020 - 3021. [Full Text] [PDF]