Living in marginalized neighborhoods linked to adverse outcomes in acute myocardial infarction

For younger acute myocardial infarction (AMI) survivors, living in marginalized neighborhoods is associated with adverse outcomes, according to a study published online July 2 in JAMA Network Open.

Leo E. Akioyamen, M.D., from the University of Toronto, and colleagues examined the association of living in a marginalized neighborhood with mortality and care for younger AMI survivors (younger than 65 years) in a universal health care system in a population-based retrospective cohort study. Data were included for 65,464 AMI patients (median age, 56 years).

The researchers found an association for increasing neighborhood marginalization with higher rates of mortality beginning 30 days after discharge and persisting over time. Mortality rates varied from 2.2% to 5.2% in the least and most marginalized quintiles (Q1 and Q5) at three years. During three years of follow-up, adjusted hazard ratios for mortality were significantly higher in patients from marginalized neighborhoods and varied from 1.13 (95% confidence interval, 0.95 to 1.35) in Q2 to 1.52 (95% confidence interval, 1.29 to 1.80) in Q5. Differences were observed between Q1 and Q5 in visits to primary care physicians (96.1% and 91.6%, respectively) and cardiologists (88.0% and 75.7%, respectively), as well as in diagnostic testing over one year.

“Our findings suggest that younger individuals may be more vulnerable to the adverse effects of neighborhood marginalization and that universal health care may be insufficient to redress outcome inequities after AMI,” the authors write.

Several authors disclosed ties to the biopharmaceutical industry.

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