Neighborhood socioeconomic status, Medicaid coverage and medical management of myocardial infarction: atherosclerosis risk in communities (ARIC) community surveillance.

TitleNeighborhood socioeconomic status, Medicaid coverage and medical management of myocardial infarction: atherosclerosis risk in communities (ARIC) community surveillance.
Publication TypeJournal Article
Year of Publication2010
AuthorsForaker RE, Rose KM, Whitsel EA, Suchindran CM, Wood JL, Rosamond WD
JournalBMC Public Health
Volume10
Pagination632
Date Published2010 Oct 21
ISSN1471-2458
KeywordsAged, Atherosclerosis, Censuses, Disease Management, Female, Health Care Surveys, Healthcare Disparities, Hospitalization, Humans, Insurance Coverage, Male, Medicaid, Middle Aged, Myocardial Infarction, Process Assessment, Health Care, Residence Characteristics, Risk Factors, Social Class, United States
Abstract

BACKGROUND: Pharmacologic treatments are efficacious in reducing post-myocardial infarction (MI) morbidity and mortality. The potential influence of socioeconomic factors on the receipt of pharmacologic therapy has not been systematically examined, even though healthcare utilization likely influences morbidity and mortality post-MI. This study aims to investigate the association between socioeconomic factors and receipt of evidence-based treatments post-MI in a community surveillance setting.

METHODS: We evaluated the association of census tract-level neighborhood household income (nINC) and Medicaid coverage with pharmacologic treatments (aspirin, beta [β]-blockers and angiotensin converting enzyme [ACE] inhibitors; optimal therapy, defined as receipt of two or more treatments) received during hospitalization or at discharge among 9,608 MI events in the ARIC community surveillance study (1993-2002). Prevalence ratios (PR, 95% CI), adjusted for the clustering of hospitalized MI events within census tracts and within patients, were estimated using Poisson regression.

RESULTS: Seventy-eight percent of patients received optimal therapy. Low nINC was associated with a lower likelihood of receiving β-blockers (0.93, 0.87-0.98) and a higher likelihood of receiving ACE inhibitors (1.13, 1.04-1.22), compared to high nINC. Patients with Medicaid coverage were less likely to receive aspirin (0.92, 0.87-0.98), compared to patients without Medicaid coverage. These findings were independent of other key covariates.

CONCLUSIONS: nINC and Medicaid coverage may be two of several socioeconomic factors influencing the complexities of medical care practice patterns.

DOI10.1186/1471-2458-10-632
Alternate JournalBMC Public Health
PubMed ID20964853
PubMed Central IDPMC3201018
Grant ListN01-HC-55022 / HC / NHLBI NIH HHS / United States
N01-HC-55016 / HC / NHLBI NIH HHS / United States
1R01HL080287 / HL / NHLBI NIH HHS / United States
N01-HC-55021 / HC / 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
R24 HD050924 / HD / NICHD NIH HHS / United States
N01-HC-55018 / HC / NHLBI NIH HHS / United States
5-T32-HL007055-30 / HL / NHLBI NIH HHS / United States