Abstract 10388: Neighborhood Socioeconomic Status and Recurrent Ischemic Events Among Patients with Incident Myocardial Infarction
Background: Longitudinal data linking neighborhood socioeconomic status (SES) to repeated ischemic events are limited. We examined ischemic event risk according to neighborhood SES in a cohort of myocardial infarction (MI) survivors.
Methods: Consecutive patients aged ≤65 years released from 8 hospitals in central Israel after first MI in 1992-3 were followed through 2005. Recurrent MI and unstable angina pectoris (UAP) leading to hospitalization were recorded. Sociodemographic and clinical data were obtained at study entry. Neighborhood SES was assessed through a composite census-derived index developed by the Israel Central Bureau of Statistics. Nonparametric techniques were applied to assess ischemic event-free survival by neighborhood SES. To account for multiple recurrent events, different variance-corrected proportional hazards models were used as appropriate: Andersen-Gill (AG), Wei-Lin-Weissfeld (WLW) and Prentice-Williams-Peterson (PWP).
Results: During a median follow-up of 13 years, 532 recurrent MI and 2,653 UAP events occurred among 1,164 patients (within-subject range: 0-4 for recurrent MI; 0-19 for UAP). Ischemic event-free survival increased steadily with increasing neighborhood SES. After adjusting for demographic variables, clinical risk factors, and individual SES measures and accounting for multiple events using the AG model, higher estimated hazards were shown in the 5th vs. 95th neighborhood SES percentiles both for recurrent MI (HR=1.55, 95% CI: 1.13-2.14) and UAP (HR=1.47, 95% CI: 1.19-1.83). The WLW and PWP models yielded similar results. When the two outcomes were combined, the respective HR (using the WLW model) was 1.74 (95% CI: 1.48-2.04).
Conclusion: In this cohort study of patients with incident MI, living in a deprived neighborhood was associated with increased risk of recurrent ischemic events beyond individual SES and baseline clinical profile.
- © 2011 by American Heart Association, Inc.