Low income tied to mortality risk after STEMI hospitalization
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ATLANTA — Patients with low household income who presented with STEMI faced greater risk for inpatient mortality, longer hospital stay and need for invasive mechanical ventilation vs. patients with higher income, a speaker reported here.
At the Society for Cardiovascular Angiography and Interventions Scientific Sessions, Abdul Mannan Khan Minhas, MD, a hospitalist at Hattiesburg Clinic Hospital Care Service in Mississippi, presented findings that individuals in the lowest quartile of household income experienced worse outcomes after STEMI compared with those in the highest quartile.
“These lower-income residents had higher prevalence of comorbidities. For example, they had the highest proportion of chronic lung disease, hypertension, diabetes, congestive HF, tobacco, drug, alcohol abuse and previous stroke,” Minhas told Healio. “These low-income individuals also had the highest proportion of having no insurance or the highest proportion of Medicaid as well. These are the few things that are translated [to mortality risk]. There could be a lot of other reasons that we could not see in our analysis, like social factors, lifestyle factors, poor nutrition and decreased access to health care.”
Researchers conducted an analysis of adult STEMI discharges from 2016 to 2018 using the National Inpatient Sample. Individuals were stratified into quartiles of median household income based on the ZIP code of the patients’ residence and outcomes were compared between each group.
Among 639,300 hospitalizations for STEMI, individuals in the lowest-income quartile represented 35.1% of cases and those in the highest-income quartile made up 19.4% of cases.
Researchers observed that adults from the lowest-income quartile presenting with STEMI experienced higher inpatient mortality (11.8% vs. 10.4%; P < .001), longer length of stay (4.9 days vs. 4.7 days; P = .003), more use of invasive mechanical ventilation (15.9% vs. 14.1%; P = .001) and lower hospital cost ($26,503.70 vs. $30,540.30; P < .001) compared with patients in the highest-income quartile.
“Why did they have lower cost per hospitalization? It's tough to say, and I could not find a good answer for that in my analysis. Usually, length of stay is one of the major factors that determines high cost, but in our analysis, the lowest-income quartile patients had highest length of stay,” Minhas told Healio. “Other things that cause high costs are having more procedures done. I looked into that ... there was just a minimal difference where high-income patients had slightly more procedures, but the difference was only around 1%. At this point, I cannot deduce from this analysis the reason why we are spending less money on low-income patients and more money on in high-income patients.”
Patients in the lowest-income quartile tended to be younger (63.5 years vs. 65.7 years) and were more likely to be women (35.7% vs. 29.8%) compared with patients with higher income.
Additionally, the lowest quartile for income had the highest proportion of Black, Hispanic and Native American patients and the lowest proportion of white and Asian or Pacific Islander patients compared with the other three quartiles.
Moreover, hospitalizations in urban hospitals were more common among patients in the highest-income quartile, whereas use of rural hospitals was more common among patients in the lowest-income quartile compared with the other quartiles of income.
“These findings have been seen in other studies too, that those presenting to rural hospitals and those belonging to underrepresented groups have had worse CV outcomes. We did observe that we had higher proportion of these underrepresented groups as well as a higher proportion of women,” Minhas told Healio. “In rural areas, social factors play a big role, like lifestyle factors, lower education, unemployment and access to preventative health care. All of these combined translated into higher mortality after heart attack.”
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Minhas AMK, et al. Abstract 6. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 19-22, 2022; Atlanta.
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