Living in areas with high vehicle ownership tied to lower odds of death after heart attack
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Key takeaways:
- Living in a neighborhood with low vehicle ownership was tied to higher risk for death after a heart attack.
- Risk was higher for Black adults compared with white adults.
Adults living in neighborhoods with low vehicle ownership have higher mortality risk after an MI compared with those residing in neighborhoods with high vehicle ownership, independent of household income, researchers reported.
Transportation is widely considered to be a fundamental social determinant of health; however, research investigating transportation disparities among people with ischemic heart disease is lacking, the researchers wrote in the American Journal of Preventive Cardiology.
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“Medications, doctor visits, diet, exercise and managing stress are all vital components in treating this progressive disease. The ability to incorporate these elements into one’s lifestyle is heavily dependent upon the ability to access reliable transportation,” Jesse J. Goitia Jr., MD, assistant professor in the division of cardiology at the University of California, Irvine, School of Medicine, and colleagues wrote in the study background. “Lack of transportation has been associated with lower adherence to medication use, inability to make it to medical appointments and limitations in accessing nutritious foods.”
In a retrospective observational study, Goitia and colleagues analyzed data from 30,126 adults admitted for MI between 2006 and 2016. The mean age of patients was 68 years and 63.2% were men. Researchers defined neighborhoods by census tract and household vehicle ownership data via the American Community Survey courtesy of the UCLA Center for Neighborhood Knowledge.
Researchers stratified patients into two groups: those living in neighborhoods with higher vehicle ownership and those living in neighborhoods with lower vehicle ownership, using the cutoff of 4.34% of households reporting not owning a vehicle to define a neighborhood as one with “higher” vs. “lower” vehicle ownership.
The primary outcome was the association between vehicle ownership and all-cause mortality after MI.
After adjusting for age, sex, race/ethnicity and medical comorbidities, lower vehicle ownership was associated with increased all-cause mortality after MI, with an adjusted HR of 1.1 (95% CI, 1.06-1.14; P < .001). Findings persisted after adjusting for median household income (aHR = 1.06; 95% CI 1.02-1.1; P = .007).
Researchers then compared white vs. Black patients who lived in neighborhoods with low vehicle ownership and found that Black adults were 21% more likely than white adults to die after an MI (aHR = 1.21; 95% CI, 1.13-1.3; P < .001), with the findings persisting after adjustment for household income (aHR = 1.2; 95% CI, 1.12-1.29; P < .001).
There were no differences between Black and white adults living in neighborhoods with high vehicle ownership, according to the researchers.
“These findings highlight the important role that transportation plays in determining health status among individuals with ischemic heart disease, particularly among Black individuals,” the researchers wrote.
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