Association of Neighborhood-Level Marginalization With Health Care Use and Clinical Outcomes Following Hospital Discharge in Patients Who Underwent Coronary Catheterization for Acute Myocardial Infarction in a Single-Payer Health Care System-Reference-Cited by-同舟云学术

Association of Neighborhood-Level Marginalization With Health Care Use and Clinical Outcomes Following Hospital Discharge in Patients Who Underwent Coronary Catheterization for Acute Myocardial Infarction in a Single-Payer Health Care System

Published:2023-12 Issue:12 Volume:16 Page:
ISSN:1941-7713
Container-title:Circulation: Cardiovascular Quality and Outcomes
language:en
Short-container-title:Circ: Cardiovascular Quality and Outcomes

Author:

Akioyamen Leo E.¹^ORCID,Abdel-Qadir Husam¹²³⁴⁵^ORCID,Han Lu³,Sud Maneesh²³⁶^ORCID,Mistry Nikhil³,Alter David A.¹²³⁴,Atzema Clare L.¹²⁶^ORCID,Austin Peter C.²^ORCID,Bhatia R. Sacha¹⁴,Booth Gillian L.²⁷^ORCID,Dhalla Irfan¹²,Ha Andrew C.T.¹⁴^ORCID,Jackevicius Cynthia A.¹²⁸^ORCID,Kapral Moira K.¹²⁴^ORCID,Krumholz Harlan M.⁹¹⁰¹¹^ORCID,Lee Douglas S.¹²³⁴^ORCID,McNaughton Candace D.¹³⁶^ORCID,Roifman Idan¹²³⁶⁷^ORCID,Schull Michael J.¹²³⁶^ORCID,Sivaswamy Atul³,Tu Karen²¹²³¹³^ORCID,Udell Jacob A.¹²³⁴⁵^ORCID,Wijeysundera Harindra C.¹²³⁶^ORCID,Ko Dennis T.¹²³⁶^ORCID

Affiliation:

1. Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada.

2. Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada.

3. ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.).

4. University Health Network, Toronto, ON, Canada (H.A.-Q., D.A.A., R.S.B., A.C.T.H., M.K.K., D.S.L., J.A.U.).

5. Women’s College Hospital, Toronto, ON, Canada (H.A.-Q., J.A.U.).

6. Sunnybrook Health Sciences Centre, Toronto, ON, Canada (M.S., C.L.A., C.D.M., I.R., M.J.S., H.C.W., D.T.K.).

7. Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada (G.L.B., I.R.,).

8. Western University of Health Sciences, Pomona, CA (C.A.J.).

9. Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (H.M.K.).

10. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (H.M.K.).

11. Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.).

12. Department of Family and Community Medicine, (K.T.), University of Toronto, ON, Canada.

13. North York General Hospital, Toronto, ON, Canada (K.T.).

Abstract

BACKGROUND: Canadian data suggest that patients of lower socioeconomic status with acute myocardial infarction receive less beneficial therapy and have worse clinical outcomes, raising questions regarding care disparities even in universal health care systems. We assessed the contemporary association of marginalization with clinical outcomes and health services use. METHODS: Using clinical and administrative databases in Ontario, Canada, we conducted a population-based study of patients aged ≥65 years hospitalized for their first acute myocardial infarction between April 1, 2010 and March 1, 2019. Patients receiving cardiac catheterization and surviving 7 days postdischarge were included. Our primary exposure was neighborhood-level marginalization, a multidimensional socioeconomic status metric. Neighborhoods were categorized by quintile from Q1 (least marginalized) to Q5 (most marginalized). Our primary outcome was all-cause mortality. A proportional hazards regression model with a robust variance estimator was used to quantify the association of marginalization with outcomes, adjusting for risk factors, comorbidities, disease severity, and regional cardiologist supply. RESULTS: Among 53 841 patients (median age, 75 years; 39.1% female) from 20 640 neighborhoods, crude 1- and 3-year mortality rates were 7.7% and 17.2%, respectively. Patients in Q5 had no significant difference in 1-year mortality (hazard ratio [HR], 1.08 [95% CI, 0.95–1.22]), but greater mortality over 3 years (HR, 1.13 [95% CI, 1.03–1.22]) compared with Q1. Over 1 year, we observed differences between Q1 and Q5 in visits to primary care physicians (Q1, 96.7%; Q5, 93.7%) and cardiologists (Q1, 82.6%; Q5, 72.6%), as well as diagnostic testing. There were no differences in secondary prevention medications dispensed or medication adherence at 1 year. CONCLUSIONS: In older patients with acute myocardial infarction who survived to hospital discharge, those residing in the most marginalized neighborhoods had a greater long-term risk of mortality, less specialist care, and fewer diagnostic tests. Yet, there were no differences across socioeconomic status in prescription medication use and adherence.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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