Abstract 16195: Socioeconomic Disadvantage is Associated With Higher Long-Term Cardiovascular Mortality Following Myocardial Infarction: The YOUNG-MI Registry

Abstract

Introduction: Living in a disadvantaged neighborhood is associated with developing cardiovascular disease and poor health outcomes. We hypothesized that socioeconomic disadvantage - as measured by neighborhood level factors - is associated with cardiovascular (CV) mortality for patients who experienced a myocardial infarction (MI) at a young age. Methods: Retrospective cohort study of patients with a first MI at age <50 years treated at two medical centers from 2000 - 2016. Each patient’s home address was mapped to their census block group (CBG), a geographically compact region containing ~ 600 to 3000 people. For each CBG, we obtained the Neighborhood Stress Score (NSS) - a standardized score based on 7 census variables that Massachusetts Medicaid uses to measure socioeconomic stress. Patients were assigned an NSS score based on their CBG and stratified into tertiles of risk. Higher scores indicate greater socioeconomic disadvantage. We used Cox proportional hazards modeling to evaluate the association of NSS with CV mortality. Results: Of 2097 patients (median age 44; 19% female), addresses were available for 96%. The median NSS score was -0.31, with scores ranging from -1.11 to 5.33. Higher NSS scores were associated with public insurance, hypertension, diabetes, smoking cigarettes, and illicit drug use. Over a median follow-up of 11 years, 12.7% of individuals in the top tertile died versus 7.5% in the bottom tertile, p=0.002. After adjusting for age, sex, race, diabetes, hypertension, dyslipidemia, creatinine, tobacco smoking, use of alcohol or illicit drugs, cardiac catheterization, and statin or aspirin at discharge, each 1-point increase in NSS was associated with a 25% increase in CV mortality (adjusted HR = 1.25, [95% CI 1.01 - 1.55], p=0.045). Conclusion: Among patients experiencing an MI at a young age, socioeconomic disadvantage was associated with higher CV mortality. Our data suggest that neighborhood factors have an important effect on post-MI survival.