How the recovery of young heart attack survivors is impacted by the world around them
After young adults experience a myocardial infarction (MI), where they live and other socioeconomic factors appear to play a key role in their long-term survival, according to new findings published in JAMA Cardiology.
“A growing body of evidence suggests that lower socioeconomic status is associated with worse cardiovascular outcomes among younger adults,” wrote lead author Adam N. Berman, MD, a cardiologist at Brigham and Women’s Hospital in Boston, said in a prepared statement. “Although the association between socioeconomic status and cardiovascular disease is well established, less is known about the role of neighborhood socioeconomic factors in outcomes after a MI, particularly in a young patient population.”
Researchers studied outcomes from more than 2,000 patients who had their first MI at the age of 50 or younger. Anyone with known coronary artery disease—defined as a previous MI or coronary revascularization—were excluded from the analysis. All patients were treated from January 2000 to April 2016 at one of two large academic medical centers in Boston, and the median follow-up time was 11.3 years. The Area Deprivation Index was used to determine when patients lived somewhere that put them at a “socioeconomic disadvantage.”
Overall, the authors wrote, living in more disadvantaged neighborhoods was directly associated with a 32% higher all-cause mortality and a 57% higher cardiovascular mortality than living in areas that weren’t viewed as being at a socioeconomic disadvantage. This was true even after making multiple adjustments that accounted for age, sex, race, insurance coverage, hypertension, drug use and other key risk factors.
Patients in the most disadvantaged neighborhoods were more likely to be Black or Hispanic and to have public insurance or no insurance at all. These patients were also more likely to smoke tobacco products or use illegal drugs.
“As a particularly vulnerable group, given the major cardiovascular event they experienced at an early age, the study findings demonstrate the independent association of neighborhood-level socioeconomic factors with mortality,” the authors wrote. “Specifically, we found an 8% increase in all-cause mortality and a 13% increase in cardiovascular mortality for each single rank increase in socioeconomic disadvantage over a median follow-up duration of 11.3 years.”
Berman et al. also wrote that their analysis “reinforces the need to better understand the underlying mechanisms that link socioeconomic disadvantage to poor outcomes in cardiovascular disease as well as the need to identify robust and comprehensive strategies to reduce this excess risk.”
The team’s full analysis is available here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.