Journal
ANNALS OF EPIDEMIOLOGY
Volume 22, Issue 8, Pages 541-546Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.annepidem.2012.04.023
Keywords
Acute coronary syndromes; Cohort studies; Multiple failure-time data analysis; Myocardial infarction; Neighborhood socioeconomic status; Survival analysis
Categories
Funding
- Israel National Institute for Health Policy and Health Services Research [r/89/2008]
- Environment and Health Fund, Jerusalem, Israel [RGA 0904]
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Purpose: Longitudinal data linking area-level socioeconomic status (SES) to repeated acute coronary syndrome (ACS) events are limited. Using multiple failure-time data, we examined the association between neighborhood SES and ACS in a community-based cohort of myocardial infarction (MI) survivors. Methods: Consecutive patients aged 65 years or younger discharged from eight hospitals in central Israel after first MI in 1992-1993 were followed through 2005. Recurrent MI and unstable angina pectoris (UAP) leading to hospitalization were recorded. Neighborhood SES was assessed through a composite census-derived index developed by the Israel Central Bureau of Statistics. Different variance-corrected proportional hazards models were used to account for multiple recurrent events: Andersen-Gill, Wei-Lin-Weissfeld (WLW), and Prentice-Williams-Peterson. Results: During follow-up, 531 recurrent Mls and 1584 UAP episodes occurred among 1164 patients. Adjusting for known prognostic factors and individual SES using the Andersen-Gill model, higher estimated hazards were associated with poor neighborhood SES (hazard ratio. 1.55; 95% confidence interval [CI], 1.13-2.14 for recurrent MI; and hazard ratio, 1.48; 95% CI, 1.22-1.79 for UAP; in the 5th vs. 95th percentiles). The WLW and Prentice-Williams-Peterson models yielded similar results. When the two outcomes were combined, the WLW-derived hazard ratio was 1.64 (95% CI, 1.39-1.93). Conclusions: MI survivors living in a deprived neighborhood are at higher risk of repeated hospital admissions because of ACS. Secondary prevention initiatives should incorporate multilevel approaches to increase effectiveness and reduce geographic health disparities. (C) 2012 Elsevier Inc. All rights reserved.
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