People from low-income areas more likely to die after a heart attack, major study says
People from low-income areas are more likely to die after a heart attack than people from high-income areas, and Canada has the largest disparity between the rich and poor in short-term mortality rates, a study found.
University of Texas Medical Branch and Harvard Medical School researchers compared the treatments and results received by heart attack patients in low-income and high-income neighbourhoods.
Researchers studied patients with two types of heart attacks, or myocardial infarctions in medical terms; severe or ST-elevation myocardial infarctions (STEMI), and non-ST-elevation myocardial infarctions (NSTEMI).
Patients with either of these conditions who were from low-income areas had higher mortality rates than patients with the same conditions but from higher-income areas. Researchers analyzed the medical records of adults 66 years or older who were hospitalized with a type of heart attack.
The results reinforce again that poverty has really consistent health impacts that seem to transcend national borders. I think that the challenge for governments, for policymakers for the health-care system is to figure out what if anything, are effective interventions that can be done," said Dr. Peter Cram.
Cram is the senior author of the paper and an adjunct scientist at ICES and The University of Texas Medical Branch.
Published in The Journal of the American Medical Association (JAMA,) the study included 289,376 patients hospitalized with STEMI and 843,046 patients hospitalized with NSTEMI.
Data was collected from six different countries including Canada - from Ontario and Manitoba specifically - the U.S., the U.K., the Netherlands, Taiwan and Israel between 2013 and 2018.
Findings showed that, despite the vast differences in health-care systems between the six countries studied, low-income patients across six different countries have mortality rates that are 10 to 20 per cent greater than their higher-income peers.
According to the study, within 30 days following hospitalization, mortality rates were one to three percentage points lower for high-income patients. The largest difference in mortality rates between high and low-income patients with STEMI was seen in Canada with 14.9 per cent and 17.8 per cent, respectively.
Differences in one-year mortality were even larger, with the highest difference in Israel, with 16.2 per cent and 25.3 per cent for high versus low-income individuals with STEMI.
Patients from low-income areas in all countries were less likely to receive necessary and recommended treatments for STEMI, including cardiac catheterisation, and revascularisation, and had lower re-admission rates to hospitals in comparison to patients from higher-income areas.
A heart attack is a deadly medical condition caused by decreased blood flow to the heart muscle, which usually happens due to a blockage in one or more of the coronary arteries. The blockage can develop due to a buildup of plaque, fat, cholesterol, or a sudden blood clot that forms on the blockage. So, most patients need medical treatment after a heart attack.
Researchers agreed that income-based disparities persist even in countries with universal health-care and robust social services.
Our results challenge the belief that income-based disparities are a uniquely American phenomenon. The truth is that the poverty penalty seems consistent across countries," said Cram.
Universal health-care may be necessary, but it seems insufficient to remedy the cumulative effects residing in a low-income neighbourhood, and then the question comes up, how might you fix or remedy that disparity? And there I think the answer is not completely clear.
All countries, including Canada, need to address these issues and improve health-care delivery for older patients who experience severe heart attacks," he said.
A country's health-care system can impact treatment and outcomes for specific health conditions, like cardiovascular disease," said Bruce Landon.
Landon is a professor of medicine at the Beth Israel Deaconess Medical Center, and a professor of Health Care Policy at Harvard Medical School.
It is still possible that there were other health-related factors that influenced higher rates of death and lower rates of treatment for low-income patients, researchers agreed.
Race and ethnicity were not adjusted for in the study because that data was not available for all countries and populations, but it was stated that all Americans who took part in the study had health insurance.
Irem Koca is an Ottawa-based general assignment reporter for the Star. Reach her via email: ikoca@thestar.ca