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
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
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