Abstract
BackgroundPharmacologic 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.MethodsWe evaluated the association of census tract-level neighborhood household income (nINC) and Medicaid coverage with pharmacologic treatments (aspirin, beta [β]-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.ResultsSeventy-eight percent of patients received optimal therapy. Low nINC was associated with a lower likelihood of receiving β-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.ConclusionsnINC and Medicaid coverage may be two of several socioeconomic factors influencing the complexities of medical care practice patterns.
Highlights
Pharmacologic treatments are efficacious in reducing post-myocardial infarction (MI) morbidity and mortality
The prescription of evidence-based treatments such as aspirin, beta-adrenergic blocking agents and angiotensin-converting enzyme (ACE) inhibitors is recommended by the American College of Cardiology (ACC)/American Heart Association (AHA) [5] and is currently monitored for improving hospital quality of care for all patients following MI [6]
We examined neighborhood socioeconomic status (SES) as a potential barrier to receipt of evidence-based medical therapy post-MI and investigated whether Medicaid coverage is associated with medical management
Summary
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. The potential influence of socioeconomic factors on the receipt of pharmacologic therapy has not been examined via surveillance of hospitalizations for MI in the United States (U.S.), even though healthcare utilization likely influences morbidity and mortality post-MI. Several investigators have used insurance status as a proxy for individual SES [20,21,22], and the validity of this approach is not known, Medicaid coverage, with the exception of limited medical conditions, is only provided to patients below the federal poverty level [23]. Acute coronary syndrome patients with Medicaid coverage were less likely to receive guidelinerecommended medications and invasive cardiac procedures compared to patients of similar age with health maintenance organization or private insurance coverage [25]
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