Neighborhood socioeconomic disparities and 1-year case fatality after incident myocardial infarction: The Atherosclerosis Risk in Communities (ARIC) Community Surveillance (1992-2002)

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• 作者：Randi E. Foraker ; PhD^a ; ^{rforaker@cph.osu.edu} ; Mehul D. Patel ; MSPH^b ; Eric A. Whitsel ; MD ; MPH^b ; Chirayath M. Suchindran ; PhD^c ; Gerardo Heiss ; MD ; PhD^b ; Kathryn M. Rose ; PhD^d
• 刊名：American Heart Journal
• 出版年：2013
• 出版时间：January, 2013
• 年：2013
• 卷：165
• 期：1
• 页码：102-107
• 全文大小：265 K

文摘

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Background

Declines in case fatality post-myocardial infarction (MI) have been observed over the past 3 decades. Few studies report socioeconomic disparities in survival post-MI.

Methods

We assessed 1-year case fatality among 9,116 incident MI patients included in the Atherosclerosis Risk in Communities community surveillance from 1992 to 2002. Addresses of hospitalized MI patients were geocoded by a commercial vendor and linked to year 2000 United States Census tract-level neighborhood income (nINC) data. We estimated case fatality odds ratios and 95 % CIs with a multinomial logistic model to quantify the association between nINC tertile and case fatality, comparing short- (within 28 days) and long-term (29-365 days) case fatality to no death 1 year post-MI.

Results

Overall, 1-year age-adjusted case fatality rates were highest among MI patients living in low-nINC areas, followed by medium- and high-nINC areas, respectively. We found significant odds ratio modification by race (P < .10) and formed race-nINC strata with high-nINC whites as the referent group. In multivariable models adjusting for age, gender, study community, and year of MI, low-nINC whites and low- and medium-nINC blacks had higher short-term case fatality than high-nINC whites. Low- and medium-nINC blacks had higher long-term case fatality compared with high-nINC whites.

Conclusions

Differences in short- and long-term case fatality by neighborhood socioeconomic factors have not been systematically studied in the United States. Surveillance efforts can be expanded to incorporate measures of the neighborhood context to examine these associations over time.