Neighborhood Disparities in Incident Hospitalized Myocardial Infarction in Four U.S. Communities: The ARIC Surveillance Study

Purpose: Hospital-based surveillance of myocardial infarction (MI) in the United States (U.S.) typically includes age, gender, and race, but not socioeconomic status (SES). We examined the association between neighborhood median household income (nINC) and incident hospitalized MI in four U.S. communities (1993-2002). Methods: Average annual indirect age-standardized MI rates were calculated using community-specific and community-wide nINC tertiles. Poisson generalized linear mixed models were used to calculate MI incidence rate ratios by tertile of census tract nINC (high nINC group referent). Results: Within community, and among all race-gender groups, those living in low nINC neighborhoods had an increased risk of MI compared to those living in high nINC neighborhoods. This association was present when both community-specific and community-wide nINC cut points were used. Blacks and, to a lesser extent, women, were disproportionately represented in low nINC neighborhoods, resulting in a higher absolute burden of MI in blacks and women living in low compared with high nINC neighborhoods. Conclusions: These findings suggest a need for the joint consideration of racial, gender, and social disparities in interventions aimed at preventing coronary heart disease.