Clinical InvestigationOutcomes, Health Policy, and Managed CareSocioeconomic disparities in outcomes after acute myocardial infarction
Section snippets
Study design and patient sample
Patients in this study were part of the PREMIER Registry, which has been described previously.16 Patients were enrolled from 19 medical centers in the United States between January 1, 2003, and June 28, 2004. Subjects came from a consecutively screened population of all patients with elevated biomarkers of myocardial injury. To be eligible, patients had to be aged ≥18 years with supporting evidence of an AMI (>20-minute ischemic signs/symptoms and/or electrocardiographic ST changes). They also
Results
Our sample included 2142 patients from 18 hospitals. Of these patients, 19% (n = 402) did not report household income. Comparison of patients who reported their income with those who did not revealed few differences. The patients not reporting income were older (mean age 63.1 vs 60.3 years, P<.001); however, there were no statistically significant differences in clinical covariates except for a slightly better prognostic risk among those who did not report their income. The sample with complete
Discussion
Our results demonstrate that patients from low socioeconomic backgrounds have higher all-cause mortality in the year after hospitalization for AMI and suggest that these differences in post-AMI mortality are largely explained by differences in patients' clinical status on arrival to the hospital. Although the low-SES groups received poorer quality of care compared with those in higher-SES groups, these quality differences only modestly attenuated the hazard ratio after adjustment for clinical
References (25)
- et al.
Poverty, process of care, and outcome in acute coronary syndromes
J Am Coll Cardiol
(2003) - et al.
Comparison of long-term outcome after acute myocardial infarction in patients never graduated from high school with that in more educated patients. Multicenter Investigation of the Limitation of Infarct Size (MILIS)
Am J Cardiol
(1993) - et al.
The PREMIER (Prospective Registry Evaluating Myocardial Infarction: Event and Recovery) Registry: evaluating the impact of myocardial infarction of patient outcomes
Am Heart J
(2006) - et al.
Socioeconomic status and outcome following acute myocardial infarction in elderly patients
Arch Intern Med
(2004) - et al.
In industrialized nations, a low socioeconomic status represents an independent predictor of mortality in patients with acute myocardial infarction
Ital Heart J
(2003) - et al.
Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction
N Engl J Med
(1999) - et al.
Long-term survival after acute myocardial infarction is lower in more deprived neighborhoods
Circulation
(2005) - et al.
An exploration of the complex relationship of socioecologic factors in the treatment and outcomes of acute myocardial infarction in disadvantaged populations
Health Serv Res
(2001) - et al.
Socioeconomic status and mortality after acute myocardial infarction
Ann Intern Med
(2006) - et al.
Socio-occupational differences in acute myocardial infarction case-fatality and coronary care in a northern Italian population
Int J Epidemiol
(2001)
Effect of socioeconomic group on incidence of, management of, and survival after myocardial infarction and coronary death: analysis of community coronary event register
BMJ
Relation of socioeconomic position to the case fatality, prognosis and treatment of myocardial infarction events; the FINMONICA MI Register Study
J Epidemiol Community Health
Cited by (0)
This work was supported by a grant from Cardiovascular Therapeutics, Inc, Palo Alto, CA, Dr Bernheim was a fellow in the Robert Wood Johnson Clinical Scholars Program at Yale University when the work was conducted, and she is currently supported by a training grant from the National Institute of Aging (T32AG1934), Bethesda, MD. Dr Spertus discloses that he has a research grant from Cardiovascular Therapeutics, Inc, and is a consultant for that company. Dr Peterson discloses that he receives research funds from Schering Plough, Kenilworth, NJ; BMS/Sanofi Aventis, New York, NY; and Merck-Schering, Whitehouse Station, NJ.