ACC.21: Survival After MI Far Worse for Black Patients from Disadvantaged Neighborhoods

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Black patients from disadvantaged neighborhoods were significantly more likely to die within 5 years after a myocardial infarction (MI) than Black patients from wealthier neighborhoods and white patients from any socioeconomic background who survive an MI, report authors of a study being presented at the American College of Cardiology’s 70th Annual Scientific Session.

The study, led by Jesse Goitia, MD, a cardiovascular fellow at Kaiser Permanente Los Angeles Medical Center revealed that Black patients from disadvantaged neighborhoods were 19% more likely to die than white patients from well-resourced neighborhoods and 14% more likely to die than white patients from disadvantaged neighborhoods.

“A key takeaway from our study is that there are a lot of social and environmental factors that can affect a person’s outcome after a heart attack,” said Goitia, MD, in a statement. “I think that a broad, overarching approach to start addressing those factors at the neighborhood level would pay dividends for businesses, health insurers, providers and patients.”

The source of data for the study was the Kaiser Permanente Southern California hospital system where investigators analyzed records from 31 747 patients with health insurance who were treated for an MI between 2006-2016.

Patients were each assigned a neighborhood disadvantage score calculated using the Area Deprivation Index (ADI)--a validated index based on 17 socioeconomic variables that determine the level of disadvantage in a given area based on address. Based on score, patients were divided into 2 groups:

• Well-resourced neighborhood: neighborhood national ranking between 1st - 25th percentile
• Disadvantaged neighborhood group: ranking between 26th - 100th percentile

ADI scoring placed 62.7% (19 904 patients) in the well-resourced neighborhood group and 37.3% (11 843 patients) in the disadvantaged neighborhood group.

Based on an average follow up of 5 years and after multivariable adjustment for age, sex, race/ethnicity, comorbidities, and medications, living in a disadvantaged neighborhood was independently associated with increased all-cause mortality after MI (hazard ratio [HR] 1.05; 95% confidence interval [CI] 1.01-1.08; p = 0.016).

Black patients from disadvantaged neighborhoods had the worst mortality of all racial/ethnic groups compared to White patients from well-resourced neighborhoods (HR 1.19; 95% CI 1.11-1.28; p<.001) as well as White patients from disadvantaged neighborhoods (HR 1.14; 95% CI 1.06-1.23; p<.001).

Outcomes among Black patients from well-resourced neighborhoods were similar to those of White patients from comparable neighborhoods.

Goita said the results have implications for addressing social determinants of health and, equally important, to help inform clinical care for patients at the individual level. “Recognizing where a patient is coming from can help providers think more about their approach to follow-up care and how to best arrange that.”

He offered the example of a patient who is having trouble arranging transportation to a clinic--for that person, he said, more frequent check-ins by phone, when feasible, might be preferable to in-person clinic visits when feasible.

Goita noted that the trends he and colleagues observed in their study would probably be similar or possibly more pronounced in other parts of the country, particularly in areas where access to health insurance varies by neighborhood.

The authors conclude by calling for further research into neighborhood disadvantage to address racial disparities and improve mortality after MI.

Dr Goitia will virtually present the study, “Racial differences in the effects of neighborhood disadvantage on long term survival after acute myocardial infarction," on Monday, May 17, at 9:45 a.m. ET.