Low income associated with higher in-hospital mortality rate after STEMI

LAS VEGAS — New research suggests that patients with STEMI who reside in low income zip codes are more likely to die in the hospital and less likely to receive timely PCI compared with those patients that reside in high income zip codes.

Researchers studied the impact of socioeconomic status on short-term outcomes and hospital resource utilization. Shikhar Agarwal, MD, MPH, cardiology fellow at Cleveland Clinic, presented the results at the Society for Cardiovascular Angiography and Interventions Scientific Sessions.

Shikhar Agarwal

“It is unfortunate that this socioeconomic divide exists in how patients are treated for a life-threatening condition,” Agarwal said in a press release. “We all need to brainstorm how it can be avoided. Every patient has the right to the best possible care, regardless of socioeconomic status.”

Using the 2003-2008 US Nationwide Inpatient Sample, the researchers identified 271,726 patients who were hospitalized with a principal diagnosis of STEMI. Socioeconomic status was categorized by median annual household income in the patient’s residential zip code, and patients were stratified into quartiles by that metric: $38,999 or less; $39,000 to $47,999; $48,000 to $62,999; or $63,000 or more.

The primary outcomes were death, length of stay of 5 days or more and timely PCI within the same day of presentation.

In-hospital mortality rate for patients in the lowest- socioeconomic status quartile was 8%, compared with 7.7% for the second-lowest quartile, 7.4% for the second-highest quartile and 7.2% for the highest socioeconomic status quartile (P<0.001). Compared with the highest socioeconomic status quartile, patients in the lowest quartile had an 11% greater risk for in-hospital mortality (OR=1.11; 95% CI, 1.04-1.18).

About 37% of patients in the lowest socioeconomic status quartile had a hospital length of stay of 5 days or more compared with 32.5% in the highest quartile (OR=1.29; 95% CI, 1.25-1.33).

Patients from low-income zip codes were 15% less likely to receive timely PCI compared with those from high-income zip codes (OR=0.85; 95% CI, 0.83-0.88), the researchers reported.

According to Agarwal, one explanation could be that there are fewer PCI-capable hospitals in low-income neighborhoods than in high-income neighborhoods; another explanation could be less awareness of signs of MI by people with lower incomes and education.

“How fast the patient arrives at the hospital can be influenced by a whole host of factors, including socioeconomic status, educational level, awareness of heart attack warning signs, ease of getting to the hospital and social support,” Agarwal said in the release. “It is important to address these issues, as the benefits of PCI are best realized in the few hours immediately after STEMI, not several hours or days later.”– by Erik Swain

For more information:

Agarwal S. Abstract A-048. Presented at: the Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 28-31, 2014; Las Vegas.

Disclosure: Agarwal reports no relevant financial disclosures.