TY - JOUR
T1 - Socioeconomic environment and recurrent coronary events after initial myocardial infarction
AU - Koren, Avshalom
AU - Steinberg, David M.
AU - Drory, Yaacov
AU - Gerber, Yariv
AU - Kishon, Yeheskiel
AU - Kriwisky, Michael
AU - Rosenman, Yoseph
AU - Uri Goldbourt, Goldbourt
AU - Hanoch Hod, Hod
AU - Eliezer Kaplinsky, Kaplinsky
AU - Michael Eldar, Eldar
AU - Itzhak Shapira, Shapira
AU - Amos Pines, Pines
AU - Margalit Drory, Drory
AU - Arie Roth, Roth
AU - Shlomo Laniado, Laniado
AU - Gad Keren, Keren
AU - David, Daniel
AU - Leibowitz, Morton
AU - Pausner, Hana
AU - Schlesinger, Zvi
AU - Vered, Zvi
AU - Alexander Battler, Battler
AU - Alejandro Solodky, Solodky
AU - Samuel Sclarovsky, Sclarovsky
AU - Izhar Zehavi, Zehavi
AU - Rachel Marom-Klibansky, Marom-Klibansky
AU - Leor, Ron
N1 - Funding Information:
The following investigators and institutions took part in the Israel Study Group on First Acute Myocardial Infarction: Yaacov Drory, MD, Principal Investigator, Department of Rehabilitation, Sackler Medical School, Tel Aviv University, Tel Aviv; Yeheskiel Kishon, MD, Michael Kriwisky, MD, and Yoseph Rosenman, MD, Wolfson Medical Center, Holon; Uri Goldbourt, PhD, Hanoch Hod, MD, Eliezer Kaplinsky, MD, and Michael Eldar, MD, Sheba Medical Center, Tel Hashomer; Itzhak Shapira, MD, Amos Pines, MD, Margalit Drory, MSW, Arie Roth, MD, Shlomo Laniado, MD, and Gad Keren, MD, Tel-Aviv Sourasky Medical Center, Tel-Aviv; Daniel David, MD, Morton Leibowitz, MD, and Hana Pausner, MD, Meir Medical Center, Kfar Sava; Zvi Schlesinger, MD, and Zvi Vered, MD, Assaf Harofeh Medical Center, Zerifin; Alexander Battler, MD, Alejandro Solodky, MD, and Samuel Sclarovsky, MD, Beilinson Medical Center, Petach Tikvah; Izhar Zehavi, MD, and Rachel Marom-Klibansky, MD, Hasharon Medical Center, Petah Tikvah; and Ron Leor, MD, Laniado Medical Center, Netanya. The authors are also indebted to Zalman Kaufman, MSc for assistance with the Geographic Information System analysis. This work was supported in part by the Israel National Institute for Health Policy and Health Services Research (grant number r/89/2008 to Drs. Drory and Gerber), and the Environment and Health Fund, Jerusalem, Israel (grant award number RGA 0904 to Dr. Gerber). The funding sources played no role in the design, conduct, or reporting of this study.
PY - 2012/8
Y1 - 2012/8
N2 - 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 MIs 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.
AB - 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 MIs 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.
KW - Acute coronary syndromes
KW - Cohort studies
KW - Multiple failure-time data analysis
KW - Myocardial infarction
KW - Neighborhood socioeconomic status
KW - Survival analysis
UR - http://www.scopus.com/inward/record.url?scp=84863854553&partnerID=8YFLogxK
U2 - 10.1016/j.annepidem.2012.04.023
DO - 10.1016/j.annepidem.2012.04.023
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AN - SCOPUS:84863854553
SN - 1047-2797
VL - 22
SP - 541
EP - 546
JO - Annals of Epidemiology
JF - Annals of Epidemiology
IS - 8
ER -
