Interesting study linking low neighbourhood income and Medicaid with longer patient delays in seeking help during early stages of heart attack. NB, time to receiving thrombolytic therapy (door-to-needle time) is the send biggest predictor of survival from heart attack after age and this therapy works best within 2 hours of symptoms onset. Acting quickly saves lives... http://archinte.ama-assn.org/cgi/content/abstract/168/17/1874?etoc <http://archinte.ama-assn.org/cgi/content/abstract/168/17/1874?etoc> Alex Randi E. Foraker, MA; Kathryn M. Rose, PhD; Aileen P. McGinn, PhD; Chirayath M. Suchindran, PhD; David C. Goff Jr, MD, PhD; Eric A. Whitsel, MD, MPH; Joy L. Wood, MS; Wayne D. Rosamond, PhD Arch Intern Med. 2008;168(17):1874-1879. 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. ************************************************************************ ' Alexander M Clark PhD BA(Hons) RN Associate Professor Alberta Heritage Population Health Investigator CIHR New Investigator Faculty of Nursing 4th Floor Clinical Sciences Building University of Alberta Edmonton, AB. Canada T6G 2G3 Tel: 001 (780) 492 8347 Fax: 001 (780) 492 2551 ------------------- Problems/Questions? Send it to Listserv owner: [log in to unmask] To unsubscribe, send the following message in the text section -- NOT the subject header -- to [log in to unmask] SIGNOFF SDOH DO NOT SEND IT BY HITTING THE REPLY BUTTON. THIS SENDS THE MESSAGE TO THE ENTIRE LISTSERV AND STILL DOES NOT REMOVE YOU. To subscribe to the SDOH list, send the following message to [log in to unmask] in the text section, NOT in the subject header. SUBSCRIBE SDOH yourfirstname yourlastname To post a message to all 1200+ subscribers, send it to [log in to unmask] Include in the Subject, its content, and location and date, if relevant. For a list of SDOH members, send a request to [log in to unmask] To receive messages only once a day, send the following message to [log in to unmask] SET SDOH DIGEST To view the SDOH archives, go to: https://listserv.yorku.ca/archives/sdoh.html