TITLE

Neighborhood Income and Individual Education: Effect on Survival After Myocardial Infarction

AUTHOR(S)
Gerber, Yariv; Weston, Susan A.; Killian, Jill M.; Therneau, Tery M.; Jacobsen, Steven J.; Roger, Véronique L.
PUB. DATE
June 2008
SOURCE
Mayo Clinic Proceedings;Jun2008, Vol. 83 Issue 6, p663
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
OBJECTIVE: To evaluate the association of neighborhood-level income and individual-level education with post-myocardial infarction (MI) mortality in community patients. PARTICIPANTS AND METHODS: From November 1, 2002, through May 31, 2006, 705 (mean±SD age, 69±15 years; 44% women) residents of Olmsted County, MN, who experienced an MI meeting standardized criteria were prospectively enrolled and followed up. The neighborhood's median household income was estimated by census tract data; education was self-reported. Demographic and clinical variables were obtained from the medical records. RESULTS: Living in a less affluent neighborhood and having a low educational level were both associated with older age and more comorbidity. During follow-up (median, 13 months), 155 patients died. Neighborhood income (hazard ratio [HR], 2.10; 95% confidence interval [CI], 1.42-3.12; for lowest [median, $34,205] vs highest [median, $60,652] tertile) and individual education (HR, 2.21; 95% CI, 1.47-3.32; for <12 vs >12 years) were independently associated with mortality risk. Adjustment for demographics and various post-MI prognostic indicators attenuated these estimates, yet excess risk persisted for low neighborhood income (HR, 1.62; 95% CI, 1.08-2.45). Modeled as a continuous variable, each $10,000 increase in annual income was associated with a 10% reduction in mortality risk (adjusted HR, 0.90; 95% CI, 0.82-0.99).CONCLUSION: In this geographically defined cohort of patients with MI, low individual education and poor neighborhood income were associated with a worse clinical presentation. Poor neighborhood income was a powerful predictor of mortality even after controlling for a variety of potential confounding factors. These data confirm the socioeconomic disparities in health after MI.
ACCESSION #
32617214

 

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