Living in a marginalized neighbourhood is associated with worse outcomes in patients with myocardial infarction

1. In acute myocardial infarction (AMI) survivors younger than the age of 65, living in a marginalized neighbourhood was associated with higher rates of mortality and hospitalizations.

Evidence Rating Level: 2 (Good)

Adults below the age of 65 are increasingly developing AMI, with the burden of coronary artery disease only expected to continue to grow in this population. Importantly, young adults may be disproportionately affected by poorer neighbourhood conditions, yet the association between adverse neighbourhood conditions and AMI outcomes in young adults remains to be investigated. This retrospective cohort study therefore, sought to investigate the association between neighbourhood marginalization (as defined by the Ontario Marginalization Index) and AMI outcomes in adults younger than 65. 65,464 patients (median age[IQR], 56[50-61]) younger than 65 with a first hospitalization for AMI between April 1st, 2010 and March 1st, 2019 from Ontario were included in the study. The primary outcome of the study was all-cause death. After adjusting for confounders, patients in the most marginalized quintile (5th quintile) were at a significantly greater risk of all-cause death (HR, 2.43; 95% CI, 1.41-4.18) and all-cause hospitalizations (HR, 1.16; 95% CI, 1.05-1.28). Three years following initial hospitalization, the adjusted hazard ratios (AHRs) remained preserved with increasing AHRs for all-cause death with increasing degrees of marginalization (2nd quintile AHR, 1.13; 95% CI, 0.95-1.35; 3rd quintile AHR, 1.25; 1.05-1.48; 4th quintile AHR, 1.35; 95% CI, 1.15-1.59; and fifth quintile AHR, 1.52; 95% CI, 1.29-1.80). Overall, this study found that among young survivors of AMI, increasing neighbourhood marginalization was associated with higher rates of all-cause mortality and hospitalizations. 

Click to read the study in JAMA Network Open

Image: PD

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