- The study analyzed data from nearly 32,000 heart attack patients.
- The results revealed that people living in under-resourced neighborhoods were 5 percent more likely to die of any cause within 5 years after a heart attack.
- Experts say physicians need to take into account a person's neighborhood when releasing them from the hospital.
Black people from under-resourced neighborhoods are significantly more likely to die within 5 years of surviving a heart attack than Black people from wealthier neighborhoods and white people of all socioeconomic backgrounds, according to a recent study by researchers from Kaiser Permanente Southern California.
The study, which was presented at the American College of Cardiology's 70th Annual Scientific Session this month, analyzed data from nearly 32,000 heart attack patients with health insurance who were treated within the Kaiser Permanente Southern California hospital system between 2006 and 2016.
The researchers assigned each patient a neighborhood disadvantage score based on their home address using the Area Deprivation Index, which assesses neighborhood disadvantage based on 17 variables, including education, income, employment, and household characteristics.
What the study found
About 20,000 patients were scored in the top 25th percentile, representing well-resourced neighborhoods, and about 12,000 were scored in the bottom 75th percentile, representing under-resourced neighborhoods.
Based on an average of 5 years of follow-up data, the results revealed that people living in under-resourced neighborhoods were 5 percent more likely to die of any cause within 5 years after a heart attack.
The research also revealed significant health disparities that seemed to vary based on neighborhood quality and potentially by race.
While Black people from well-resourced neighborhoods had outcomes close to those of white people from similar neighborhoods, Black people from under-resourced neighborhoods were 19 percent more likely to die than white patients from well-resourced neighborhoods and 14 percent more likely to die than white people from under-resourced neighborhoods.
There was no significant difference in the likelihood of death between white people from well-resourced neighborhoods and white people from under-resourced neighborhoods.
The study highlights the influence of environment on an individual’s health and shines a spotlight on how factors like poverty affect outcomes.
“I believe this study sheds new insight on social determinants of health, and that poor outcomes after a heart attack may in part be determined based on where you live more so than your ethnicity,” said Dr. Sakima Smith, a cardiologist and chief diversity and inclusion officer at The Ohio State University Wexner Medical Center’s Heart and Vascular Center.
Added Melody Goodman, PhD, associate dean for research at New York University’s School of Global Public Health: “In public health, we know that where we work, play, and live impacts health outcomes. Where you live really matters, particularly because of the way racism is embedded itself into the structures of the country. Based on a zip code, we can predict more about a person’s health. Economics matters. Poverty is the biggest killer in the United States.”
How to better help people after a heart attack
Dr. Jesse Goitia, a cardiology fellow at Kaiser Permanente Los Angeles Medical Center and the study’s lead author, said healthcare professionals need to be sensitive to some of the challenges confronted by this population of patients after they’re discharged.
Goitia added that healthcare professionals should also consider alternative ways of meeting the medical needs of patients, including arranging to have their medication delivered to them if they lack access to transportation or virtual doctor’s appointments.
Smith said the biggest takeaway of the study is that outcomes for Black people from well-resourced neighborhoods are similar to that of white people.
“Yet there remains a critical gap with persistently poor outcomes with respect to [Black people] from lower-performing neighborhoods, and this needs to be addressed and studied moving forward,” she added.
Goitia said future studies could use the index to study patients outside of the Kaiser network. He suspects that the differences among patients with more marginal health insurance would be more pronounced.
For many heart attack patients, several key environmental factors play a significant role in recovery, said Dr. Paul Lawrence Douglass, an interventionist cardiologist and assistant professor at Morehouse School of Medicine in Atlanta. “Are you living in a food desert? Do you live in an environment that is safe so you can exercise? [Lack of access to] transportation provides a significant barrier, particularly for some people in rural areas.”
Smith said the various tiers of government play a key role in adequately assessing neighborhood resources, health infrastructure, and access to quality care, and ensuring that it is a priority.
“Support should be provided to neighborhoods that could fall short of these key metrics,” she said. “This is a basic tenet of primary prevention and can have a significant downstream benefit to the community and the population as a whole.”
Douglass, who serves as chair of the American College of Cardiology’s health equity task force, said the task force has developed strategies to help meet health equity goals, including incorporating these goals into all of their certifications, being more cognizant of social justice in healthcare, and learning how to be anti-racist.
“We want to be positioned to have the tools available to remedy what undermines health in our community. We are trying to determine metrics to help us measure our impact,” he said. “We also want to build the argument that disparities in healthcare increases the healthcare budget overall. We are hoping that if we can vocalize this and get members to buy in, the college will continue to be an innovative leader in the medical space.”