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Cited by 122Health disparities and outcomesAcute Myocardial Infarction ResearchCardiac Health and Mental Health

Long-term survival after acute myocardial infarction is lower in more deprived neighborhoods

Tonne, Cathryn, Schwartz, Joel, Mittleman, Murray, Melly, Steve, Suh, Helen, Goldberg, Robert·2005·Circulation
DOI 10.1161/circulationaha.104.496174
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Abstract

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.

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  • Low socio-economic status is associated with increased all-cause and CVD mortality risk (RR 1.3-2.0).

    “Multiple prospective studies have shown that men and women with low socio-economic status, defined as low educational level, low income, holding a low-status job, or living in a poor residential area, have an increased all-cause as well as CVD mortality risk [relative risk (RR) 1.3 -2.0].87 -91”

    From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [89]

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Authors
Tonne, C., Schwartz, J., Mittleman, M., Melly, S., Suh, H., & Goldberg, R.
Affiliations
  • Beth Israel Deaconess Medical Center (US)
  • 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.).
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2005-06-14
Volume
111
Issue
23
Pages
3063-3070
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/circulationaha.104.496174
OpenAlex
W2078685392
Cited by
122
References
37
Citations by year
2025: 2 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 3 · 2019: 3 · 2018: 3 · 2017: 3 · 2016: 6 · 2015: 9 · 2014: 7 · 2013: 12 · 2012: 11
FWCI
10.83
Type
journal article
Language
en
Open access
closed
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Heart, Lung, and Blood Institute (T32 HL07427, R01HL35434, R01HL035434, RO1 HL35434, T32HL007427)
  • National Institute of Environmental Health Sciences (ES0002, R01ES011636, P30ES000002)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Keywords
acute myocardial infarction, long-term survival, socioeconomic position, neighborhood disadvantage, poverty, educational attainment, post-discharge mortality, urban health disparities
MeSH terms
Aged, Aged, 80 and over, Boston, Education, Female, Follow-Up Studies, Humans, Male, Myocardial Infarction, Poverty Areas, Predictive Value of Tests, Regression Analysis, Residence Characteristics, Socioeconomic Factors, Survival Rate

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