TY - JOUR
T1 - Neighborhood socioeconomic status, Medicaid coverage and medical management of myocardial infarction
T2 - Atherosclerosis risk in communities (ARIC) community surveillance
AU - Foraker, Randi E.
AU - Rose, Kathryn M.
AU - Whitsel, Eric A.
AU - Suchindran, Chirayath M.
AU - Wood, Joy L.
AU - Rosamond, Wayne D.
N1 - Funding Information:
The authors thank the staff of the ARIC study for their important contributions. This research was supported by NHLBI grant 1R01HL080287 and was also funded in part by National Institutes of Health, NHLBI, and National Research Service Award training grant 5-T32-HL007055-30. The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022.
PY - 2010
Y1 - 2010
N2 - Background. Pharmacologic treatments are efficacious in reducing post-myocardial infarction (MI) morbidity and mortality. The potential influence of socioeconomic factors on the receipt of pharmacologic therapy has not been systematically examined, even though healthcare utilization likely influences morbidity and mortality post-MI. This study aims to investigate the association between socioeconomic factors and receipt of evidence-based treatments post-MI in a community surveillance setting. Methods. We evaluated the association of census tract-level neighborhood household income (nINC) and Medicaid coverage with pharmacologic treatments (aspirin, beta []-blockers and angiotensin converting enzyme [ACE] inhibitors; optimal therapy, defined as receipt of two or more treatments) received during hospitalization or at discharge among 9,608 MI events in the ARIC community surveillance study (1993-2002). Prevalence ratios (PR, 95% CI), adjusted for the clustering of hospitalized MI events within census tracts and within patients, were estimated using Poisson regression. Results. Seventy-eight percent of patients received optimal therapy. Low nINC was associated with a lower likelihood of receiving -blockers (0.93, 0.87-0.98) and a higher likelihood of receiving ACE inhibitors (1.13, 1.04-1.22), compared to high nINC. Patients with Medicaid coverage were less likely to receive aspirin (0.92, 0.87-0.98), compared to patients without Medicaid coverage. These findings were independent of other key covariates. Conclusions. nINC and Medicaid coverage may be two of several socioeconomic factors influencing the complexities of medical care practice patterns.
AB - Background. Pharmacologic treatments are efficacious in reducing post-myocardial infarction (MI) morbidity and mortality. The potential influence of socioeconomic factors on the receipt of pharmacologic therapy has not been systematically examined, even though healthcare utilization likely influences morbidity and mortality post-MI. This study aims to investigate the association between socioeconomic factors and receipt of evidence-based treatments post-MI in a community surveillance setting. Methods. We evaluated the association of census tract-level neighborhood household income (nINC) and Medicaid coverage with pharmacologic treatments (aspirin, beta []-blockers and angiotensin converting enzyme [ACE] inhibitors; optimal therapy, defined as receipt of two or more treatments) received during hospitalization or at discharge among 9,608 MI events in the ARIC community surveillance study (1993-2002). Prevalence ratios (PR, 95% CI), adjusted for the clustering of hospitalized MI events within census tracts and within patients, were estimated using Poisson regression. Results. Seventy-eight percent of patients received optimal therapy. Low nINC was associated with a lower likelihood of receiving -blockers (0.93, 0.87-0.98) and a higher likelihood of receiving ACE inhibitors (1.13, 1.04-1.22), compared to high nINC. Patients with Medicaid coverage were less likely to receive aspirin (0.92, 0.87-0.98), compared to patients without Medicaid coverage. These findings were independent of other key covariates. Conclusions. nINC and Medicaid coverage may be two of several socioeconomic factors influencing the complexities of medical care practice patterns.
UR - http://www.scopus.com/inward/record.url?scp=77958038502&partnerID=8YFLogxK
U2 - 10.1186/1471-2458-10-632
DO - 10.1186/1471-2458-10-632
M3 - Article
C2 - 20964853
AN - SCOPUS:77958038502
SN - 1471-2458
VL - 10
JO - BMC Public Health
JF - BMC Public Health
M1 - 632
ER -