Key result
Lower neighborhood socioeconomic status was associated with higher all-cause mortality after MI compared with the upper SES tertile (HR 1.47; 95% CI 1.05-2.06).
Why the study?
Does lower neighborhood socioeconomic status increase all-cause and cardiac mortality in patients ≤65 years of age after incident MI?
Cohort (n=1,179)
Yes
Does lower neighborhood socioeconomic status increase all-cause and cardiac mortality in patients ≤65 years of age after incident MI?
Neighborhood socioeconomic status is an independent predictor of long-term all-cause and cardiac mortality after myocardial infarction, beyond individual socioeconomic status.
Answers are grounded in this paper and cite their sources.
Neighborhood SES may inform post-MI risk stratification beyond individual factors; hypothesis-generating for disparity-focused interventions.
BACKGROUND: Neighborhood of residence has been suggested to affect cardiovascular risk above and beyond personal socioeconomic status (SES). However, such data are currently lacking for patients with myocardial infarction (MI). We examined all-cause and cardiac mortality according to neighborhood SES in a cohort of MI patients. METHODS AND RESULTS: Consecutive patients < or =65 years of age discharged from 8 hospitals in central Israel after incident MI in 1992 to 1993 were followed up through 2005. Individual data were obtained at study entry, including education, income, and employment. Neighborhood SES was estimated through a composite census-derived index developed by the Israel Central Bureau of Statistics. During follow-up, 326 deaths occurred in 1179 patients. Patients residing in disadvantaged neighborhoods had higher mortality rates, with 13-year survival estimates of 61%, 74%, and 82% in increasing tertiles (P(trend)<0.001). After adjustment for sociodemographic variables, traditional risk factors, MI severity indexes, and individual SES measures, the hazard ratios for death associated with neighborhood SES were 1.47 (95% confidence interval, 1.05 to 2.06) in the lower and 1.19 (95% confidence interval, 0.86 to 1.63) in the middle tertiles compared with the upper tertile (P(trend)=0.02). The respective hazard ratios were even stronger for cardiac death (1.63; 95% confidence interval, 1.09 to 2.25; and 1.41; 95% confidence interval, 0.96 to 2.07). In the final models, neighborhood context and several individual SES measures were concurrently associated with all-cause and cardiac mortality. CONCLUSIONS: Neighborhood SES is strongly associated with long-term survival after MI. The association is partly, but not entirely, attributable to individual SES and clinical characteristics. These data support a multidimensional relationship between SES and MI outcome.
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Gerber et al. (2010) conducted a cohort in Myocardial Infarction (n=1,179). Lower neighborhood socioeconomic status vs. Upper tertile of neighborhood socioeconomic status was evaluated on All-cause mortality (HR 1.47, 95% CI 1.05 to 2.06, p=0.02). Lower neighborhood socioeconomic status was associated with higher all-cause mortality after MI compared with the upper SES tertile (HR 1.47; 95% CI 1.05-2.06).
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