TY - JOUR
T1 - Neighborhood income, health insurance, and prehospital delay for myocardial infarction
T2 - The atherosclerosis risk in communities study
AU - Foraker, Randi E.
AU - Rose, Kathryn M.
AU - McGinn, Aileen P.
AU - Suchindran, Chirayath M.
AU - Goff, David C.
AU - Whitsel, Eric A.
AU - Wood, Joy L.
AU - Rosamond, Wayne D.
PY - 2008/9/22
Y1 - 2008/9/22
N2 - Background: Outcomes following an acute myocardial infarction (AMI) are generally more favorable if prehospital delay time is minimized. Methods: We examined the association of neighborhood household income (nINC) and health insurance status with prehospital delay among a weighted sample of 9700 men and women with a validated, definite, or probable AMI in the Atherosclerosis Risk in Communities (ARIC) community surveillance study (1993-2002). Weighted multinomial regression with generalized estimation equations was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) and to account for the clustering of patients within census tracts. Results: Low nINC was associated with a higher odds of long vs short delay (OR, 1.46; 95% CI, 1.09-1.96) and medium vs short delay (OR, 1.43; 95% CI, 1.12-1.81) compared with high nINC in a model including age, sex, race, diabetes, hypertension, presence of chest pain, arrival at the hospital via emergency medical service, distance from residence to hospital, study community, and year of AMI event. Meanwhile, compared with patients with prepaid insurance or prepaid plus Medicare, patients with Medicaid were more likely to have a long vs short delay (OR, 1.87; 95% CI, 1.10-3.19) and a medium vs short delay (OR, 1.76; 95% CI, 1.13-2.74). Conclusions: Both low nINC and being a Medicaid recipient are associated with longer prehospital delay. Reducing socioeconomic and insurance disparities in prehospital delay is critical because excess delay time may hinder effective care for AMI.
AB - Background: Outcomes following an acute myocardial infarction (AMI) are generally more favorable if prehospital delay time is minimized. Methods: We examined the association of neighborhood household income (nINC) and health insurance status with prehospital delay among a weighted sample of 9700 men and women with a validated, definite, or probable AMI in the Atherosclerosis Risk in Communities (ARIC) community surveillance study (1993-2002). Weighted multinomial regression with generalized estimation equations was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) and to account for the clustering of patients within census tracts. Results: Low nINC was associated with a higher odds of long vs short delay (OR, 1.46; 95% CI, 1.09-1.96) and medium vs short delay (OR, 1.43; 95% CI, 1.12-1.81) compared with high nINC in a model including age, sex, race, diabetes, hypertension, presence of chest pain, arrival at the hospital via emergency medical service, distance from residence to hospital, study community, and year of AMI event. Meanwhile, compared with patients with prepaid insurance or prepaid plus Medicare, patients with Medicaid were more likely to have a long vs short delay (OR, 1.87; 95% CI, 1.10-3.19) and a medium vs short delay (OR, 1.76; 95% CI, 1.13-2.74). Conclusions: Both low nINC and being a Medicaid recipient are associated with longer prehospital delay. Reducing socioeconomic and insurance disparities in prehospital delay is critical because excess delay time may hinder effective care for AMI.
UR - http://www.scopus.com/inward/record.url?scp=52649141119&partnerID=8YFLogxK
U2 - 10.1001/archinte.168.17.1874
DO - 10.1001/archinte.168.17.1874
M3 - Article
C2 - 18809814
AN - SCOPUS:52649141119
SN - 0003-9926
VL - 168
SP - 1874
EP - 1879
JO - Archives of internal medicine
JF - Archives of internal medicine
IS - 17
ER -