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"Roberts, Barbara H. MD" <[log in to unmask]>@healthnet.org on
11/17/2003 11:48:34 PM

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Subject:    PROCOR: Poor neighborhood linked to poor heart attack survival



American Heart Association meeting report:
Poor neighborhood linked to poor heart attack survival


Orlando, Fla., Nov. 11 - Living in a low-income neighborhood
increases the risk of death after a heart attack, researchers
reported today at the American Heart Association's Scientific
Sessions 2003.

"Patients living in neighborhoods with a high percentage of
residents living below the poverty line had a death rate after
heart attack 30 percent higher than those in the wealthiest neighborhoods,"
said
lead author Cathryn Tonne, M.P.H., a
doctoral candidate in environmental epidemiology at
Harvard's School of Public Health in Boston, Mass.

The poverty line is an income threshold based on family size,
age of children and income.  In 1999, the poverty threshold for
a family of four was $17,029 per year.

Researchers used data from the ongoing Worcester Heart Attack
Study, a community-wide study of trends in the incidence and
survival after heart attack among residents from Worcester, Mass.

The study includes 2,539 confirmed cases of heart attack collected
in 1995, 1997 and 1999.  About 58 percent of the patients were male
and the average age was 69.  About 74 percent were still alive at
follow-up on Dec. 31, 2001.

Researchers divided income levels into five groups.  The death rate
after heart attack was higher for the 20 percent of patients living
in the poorest neighborhoods.

The analysis adjusted for demographic characteristics, hospital
discharge and other conditions such as hypertension, diabetes, a
history of chest pain, heart failure and stroke.

The lack of local health clinics and low-cost healthful foods, and
inadequate public space for physical activity may be some factors
involved in the higher risk of death after heart attack among those living
in
poverty, Tonne said.

"The precise pathways by which poverty at the neighborhood level
affects survival have not yet been identified, but residents of
deprived neighborhoods may be of poorer overall health and
experience more psychosocial factors like stress, social isolation
and depression," she said.

"The relationship between poor survival after heart attack and
neighborhood poverty may also be due in part to exposure to
traffic-related pollutants, housing conditions and other aspects
of the physical environment.

The findings of the study show that even in a relatively small
geographical urban area there can be a wide variation in heart
attack survival, which appears to be associated with poverty.
"A greater understanding of the pathways by which poverty affects survival
after
a heart attack may help us design more focused
programs to counteract poverty's effects," Tonne said.  "Our
results suggest that steps need to be taken to prevent excess
death after heart attack at the neighborhood level in addition
to those taken at the individual level."

Co-authors are Joel Schwartz, Murray Mittleman, Steve Melly,
Helen Suh and Robert Goldberg.

Contact:
For information Nov. 9-12 call:
Carole Bullock or Bridgette McNeill
at the Orange County Convention Center
(407) 685-5402

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