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Original Investigation
May 19, 2021

Association of Socioeconomic Disadvantage With Long-term Mortality After Myocardial Infarction: The Mass General Brigham YOUNG-MI Registry

Author Affiliations
  • 1Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 2Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
  • 3Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester
  • 4Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
  • 5Cardiovascular Division, New York Presbyterian-Columbia University Irving Medical Center, New York
  • 6Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 7Department of Cardiology, Houston Methodist Hospital, Houston, Texas
JAMA Cardiol. Published online May 19, 2021. doi:10.1001/jamacardio.2021.0487
Key Points

Question  Is neighborhood-level socioeconomic disadvantage associated with higher long-term mortality after a first myocardial infarction at a young age?

Findings  In this cohort study of 2097 patients who experienced their first myocardial infarction at or before 50 years of age, living in more socioeconomically disadvantaged neighborhoods was associated with a statistically significantly higher all-cause and cardiovascular mortality over an 11-year follow-up period.

Meaning  Results of this study suggest that, among individuals who experienced their first myocardial infarction at a young age, neighborhood and socioeconomic factors played a role in long-term survival.

Abstract

Importance  Socioeconomic disadvantage is associated with poor health outcomes. However, whether socioeconomic factors are associated with post–myocardial infarction (MI) outcomes in younger patient populations is unknown.

Objective  To evaluate the association of neighborhood-level socioeconomic disadvantage with long-term outcomes among patients who experienced an MI at a young age.

Design, Setting, and Participants  This cohort study analyzed patients in the Mass General Brigham YOUNG-MI Registry (at Brigham and Women’s Hospital and Massachusetts General Hospital in Boston, Massachusetts) who experienced an MI at or before 50 years of age between January 1, 2000, and April 30, 2016. Each patient’s home address was mapped to the Area Deprivation Index (ADI) to capture higher rates of socioeconomic disadvantage. The median follow-up duration was 11.3 years. The dates of analysis were May 1, 2020, to June 30, 2020.

Exposures  Patients were assigned an ADI ranking according to their home address and then stratified into 3 groups (least disadvantaged group, middle group, and most disadvantaged group).

Main Outcomes and Measures  The outcomes of interest were all-cause and cardiovascular mortality. Cause of death was adjudicated from national registries and electronic medical records. Cox proportional hazards regression modeling was used to evaluate the association of ADI with all-cause and cardiovascular mortality.

Results  The cohort consisted of 2097 patients, of whom 2002 (95.5%) with an ADI ranking were included (median [interquartile range] age, 45 [42-48] years; 1607 male individuals [80.3%]). Patients in the most disadvantaged neighborhoods were more likely to be Black or Hispanic, have public insurance or no insurance, and have higher rates of traditional cardiovascular risk factors such as hypertension and diabetes. Among the 1964 patients who survived to hospital discharge, 74 (13.6%) in the most disadvantaged group compared with 88 (12.6%) in the middle group and 41 (5.7%) in the least disadvantaged group died. Even after adjusting for a comprehensive set of clinical covariates, higher neighborhood disadvantage was associated with a 32% higher all-cause mortality (hazard ratio, 1.32; 95% CI, 1.10-1.60; P = .004) and a 57% higher cardiovascular mortality (hazard ratio, 1.57; 95% CI, 1.17-2.10; P = .003).

Conclusions and Relevance  This study found that, among patients who experienced an MI at or before age 50 years, socioeconomic disadvantage was associated with higher all-cause and cardiovascular mortality even after adjusting for clinical comorbidities. These findings suggest that neighborhood and socioeconomic factors have an important role in long-term post-MI survival.

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