"Patients living in neighborhoods with a high percentage of residents living below the poverty line had a death rate after heart attack 30 percent higher than those in the wealthiest neighborhoods," said lead author Cathryn Tonne, M.P.H., a doctoral candidate in environmental epidemiology at Harvard's School of Public Health in Boston, Mass.
The poverty line is an income threshold based on family size, age of children and income. In 1999, the poverty threshold for a family of four was $17,029 per year.
Researchers used data from the ongoing Worcester Heart Attack Study, a community-wide study of trends in the incidence and survival after heart attack among residents from Worcester, Mass.
The study includes 2,539 confirmed cases of heart attack collected in 1995, 1997 and 1999. About 58 percent of the patients were male and the average age was 69. About 74 percent were still alive at follow-up on Dec. 31, 2001.
Researchers divided income levels into five groups. The death rate after heart attack was higher for the 20 percent of patients living in the poorest neighborhoods.
The analysis adjusted for demographic characteristics, hospital discharge and other conditions such as hypertension, diabetes, a history of chest pain, heart failure and stroke.
The lack of local health clinics and low-cost healthful foods, and inadequate public space for physical activity may be some factors involved in the higher risk of death after heart attack among those living in poverty, Tonne said.
"The precise pathways by which poverty at the neighborhood level affects survival have not
yet been identified, but residents of deprived neighborhoods may be of poorer overall health and experience more psychosocial factors like stress, social isolati
Contact: Carole Bullock
American Heart Association