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Higher MI hospitalization rates persist in low-income counties
Americans living in low-income counties still have higher rates of MI hospitalization despite decline in MI across all income levels, researchers reported in JAMA Cardiology.
“The rate of decline for [MI] is similar regardless of economic status. But lower-income communities with historically higher rates of [MI] hospitalizations still have not caught up,” Erica Spatz, MD, assistant professor of medicine at Yale School of Medicine and a clinical investigator at the Center for Outcomes Research & Evaluation, said in a press release. “In fact, they lag 4 years behind wealthier communities.”
Spatz and colleagues conducted an observational study to determine whether risk-standardized acute MI hospitalization and 1-year mortality rates varied on the county level by income.
60,056,069 patients aged at least 65 years enrolled in Medicare between 1999 and 2013. United States census data were used to stratify the counties by income. Primary endpoints included risk-standardized acute MI hospitalizations and 1-year mortality after MI.
Hospitalization trend
According to the results, income was associated with hospitalization, but not mortality. Mortality rates at 1 year after hospital implantation in 1999 were 31.5% in high-income counties, 31.4% in average-income counties and 31.1% in low-income counties. In 2013, 1-year mortality rates were 26.2% in high-income counties, 26.1% in average-income counties and 25.4% in low-income counties.
In 1999, an increase in 1 interquartile range of median county consumer price index-adjusted income (approximately $12,000) directly correlated with a decrease in 46 hospitalizations per 100,000 person-years. In 2013, it was linked to a decrease in 37 hospitalizations per 100,000 person-years.
The largest variations were observed between the high-income counties and the low-income counties. In 1999, the hospitalization rates were 1,353 vs. 1,123 per 100,000 person-years, and in 2013, they were 853 vs. 648 per 100,000 person-years.
While the rates of decline in hospitalization for acute MI were similar across income groups, the low-income counties lagged behind the high-income ones by 4.3 years (95% CI, 3.1-5.9), the researchers wrote.
“Our results suggest a need for targeted approaches to reduce incidents of [MI] among low-income communities,” Spatz said in the release.
Cause for concern
In an accompanying editorial, Karen E. Joynt, MD, MPH, of the division of cardiovascular medicine, department of medicine, Brigham and Women’s Hospital, and Thomas M. Maddox, MD, MSc, section of cardiology, Veterans Affairs Eastern Colorado Health Care System and the department of medicine of the University of Colorado School of Medicine, wrote: “The fact that [acute] MI hospitalization rates, although also declining over time, continue to demonstrate disparities between low- and high-income counties, with rates of [acute] MI hospitalization in this study approximately 20% higher in low-income counties, is a concern.
Thomas M. Maddox
“This finding, which has been previously reported at the neighborhood level, suggests that, to reduce disparities in [CV] outcomes, we may need to look ‘upstream’ in the care continuum and outside the health care delivery system to two additional areas: clinical prevention efforts in the outpatient setting, particularly in primary prevention, and social determinants of health,” Joynt and Maddox wrote. – by Tracey Romero
Disclosure: Spatz reports receiving funding from CMS and a grant from the Agency for Healthcare Research and Quality Patient-Centered Outcomes Research (PCOR) Institutional Mentored Career Development Program. Please see the full study for a list of all other researchers’ relevant financial disclosures. Joynt and Maddox report no relevant financial disclosures.