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