Neighborhood income, health insurance, and prehospital delay for myocardial infarction: the atherosclerosis risk in communities study.

TitleNeighborhood income, health insurance, and prehospital delay for myocardial infarction: the atherosclerosis risk in communities study.
Publication TypeJournal Article
Year of Publication2008
AuthorsForaker RE, Rose KM, McGinn AP, Suchindran CM, Goff DC, Whitsel EA, Wood JL, Rosamond WD
JournalArch Intern Med
Volume168
Issue17
Pagination1874-9
Date Published2008 Sep 22
ISSN1538-3679
KeywordsFemale, Hospitalization, Humans, Income, Insurance, Health, Male, Medicare, Myocardial Infarction, Residence Characteristics, Socioeconomic Factors, Time Factors, Treatment Outcome, United States
Abstract

BACKGROUND: Outcomes following an acute myocardial infarction (AMI) are generally more favorable if prehospital delay time is minimized.

METHODS: We examined the association of neighborhood household income (nINC) and health insurance status with prehospital delay among a weighted sample of 9700 men and women with a validated, definite, or probable AMI in the Atherosclerosis Risk in Communities (ARIC) community surveillance study (1993-2002). Weighted multinomial regression with generalized estimation equations was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) and to account for the clustering of patients within census tracts.

RESULTS: Low nINC was associated with a higher odds of long vs short delay (OR, 1.46; 95% CI, 1.09-1.96) and medium vs short delay (OR, 1.43; 95% CI, 1.12-1.81) compared with high nINC in a model including age, sex, race, diabetes, hypertension, presence of chest pain, arrival at the hospital via emergency medical service, distance from residence to hospital, study community, and year of AMI event. Meanwhile, compared with patients with prepaid insurance or prepaid plus Medicare, patients with Medicaid were more likely to have a long vs short delay (OR, 1.87; 95% CI, 1.10-3.19) and a medium vs short delay (OR, 1.76; 95% CI, 1.13-2.74).

CONCLUSIONS: Both low nINC and being a Medicaid recipient are associated with longer prehospital delay. Reducing socioeconomic and insurance disparities in prehospital delay is critical because excess delay time may hinder effective care for AMI.

DOI10.1001/archinte.168.17.1874
Alternate JournalArch. Intern. Med.
PubMed ID18809814
PubMed Central IDPMC4682553
Grant ListN01HC55020 / HL / NHLBI NIH HHS / United States
N01-HC-55022. / HC / NHLBI NIH HHS / United States
N01HC55018 / HL / NHLBI NIH HHS / United States
N01-HC-55016 / HC / NHLBI NIH HHS / United States
N01HC55022 / HL / NHLBI NIH HHS / United States
1R01HL080287 / HL / NHLBI NIH HHS / United States
N01-HC-55021 / HC / NHLBI NIH HHS / United States
N01HC55015 / HL / NHLBI NIH HHS / United States
R01 HL080287 / HL / NHLBI NIH HHS / United States
N01-HC-55019 / HC / NHLBI NIH HHS / United States
N01-HC-55015 / HC / NHLBI NIH HHS / United States
N01-HC-55020 / HC / NHLBI NIH HHS / United States
N01HC55016 / HL / NHLBI NIH HHS / United States
N01HC55019 / HL / NHLBI NIH HHS / United States
N01-HC-55018 / HC / NHLBI NIH HHS / United States
N01HC55021 / HL / NHLBI NIH HHS / United States
T32 HL007055 / HL / NHLBI NIH HHS / United States
5-T32-HL007055-30 / HL / NHLBI NIH HHS / United States