Abstract 17909: Association of Neighborhood Socioeconomic Status with Angina, Rehospitalization, and Mortality After Acute Myocardial Infarction
Background Although low socioeconomic status (SES) is associated with increased mortality after acute myocardial infarction (AMI), few studies have examined the influence of both patients’ personal SES and the environment in which they live. To date, no studies have examined the association of neighborhood-level SES with rehospitalization and health status outcomes. In this abstract we focus on angina.
Methods We conducted a descriptive, exploratory analysis to test the association between neighborhood SES and outcomes and present here the angina (assessed by the Seattle Angina Questionnaire), mortality, and rehospitalization analyses. We used data from the PREMIER study, including 2321 patients with AMI from 19 US hospitals. We measured neighborhood SES with an established summary score incorporating income, wealth, education, and occupation in the census block group of residence. Multivariable models adjusted for patient-level factors, including demographics, personal income, education, employment, and patient-reported difficulty in “making ends meet” and paying for healthcare, to define the associations between neighborhood SES quintiles and outcomes.
Results After adjusting for demographics and patient SES, patients from neighborhoods in the lowest and second-lowest SES quintiles had a greater risk of angina (Q1: OR=1.56, 95% CI 1.09 to 2.24; Q2: OR=1.49, 95% CI 1.05 to 2.10) than patients from the highest SES neighborhoods. Residence in the lowest quintile of neighborhoods was associated with greater age and sex- adjusted risks of 1-year rehospitalization (HR=1.36, CI 1.09 to 1.70) and 4-year mortality (HR=1.74, CI 1.30 to 2.34). The association with mortality was attenuated after full adjustment (HR=1.01, CI 0.72 to 1.41), but a trend toward higher rehospitalization risk persisted (HR=1.22, CI 0.95 to 1.57).
Conclusion After adjusting for patient-level SES, we found that living in a low SES neighborhood in the United States is associated with greater prevalence of angina following AMI and a trend towards more rehospitalizations. Public policy targeting the environmental factors that underlie these associations might improve equity in health outcomes.
- © 2012 by American Heart Association, Inc.