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Researchers evaluated data on more than 132,000 white heart attack
patients and almost 9,000 black patients covered by Medicare, the
government health program for the elderly and disabled. They used
postal codes to assess income levels in patients’ communities.
After 17 years of follow-up, the overall survival rate was 7.4
percent for white patients and 5.7 percent for black patients,
according to the results published in Circulation, the journal of
the American Heart Association.
On average, across all ages, white patients in low-income areas
lived longer after a heart attack – about 5.6 years compared with
5.4 years for black patients. But in high-income communities, the
gap widened to a life expectancy of seven years for white people and
6.3 years for black individuals.
“We found that socioeconomic status did not explain the racial
disparities in life expectancy after a heart attack,” lead study
author Dr. Emily Bucholz of Boston Children’s Hospital said by
email.
“Contrary to common belief, this suggests that improving
socioeconomic standing may improve outcomes for black and white
patients globally but is unlikely to eliminate racial disparities in
health,” Bucholz added.
To see how race and class impact heart attack outcomes, Bucholz and
colleagues reviewed health records collected from 1994 to 1996 for
patients aged 65 to 90 years.
Just 6.3 percent of the patients were black, and only 6.8 percent
lived in low-income communities, based on the typical household
income in their postal codes.
Among white patients under 80, life expectancy was longest for
patients in the most affluent neighborhoods and it got progressively
shorter for middle-income and poor communities, the study found.
By contrast, life expectancy was similar for black patients residing
in poor and middle-income communities across all ages. Only black
patients under age 75 living in affluent areas had a survival
advantage compared with their peers in less wealthy neighborhoods.
One shortcoming of the study is that it included a small proportion
of black and poor patients, the authors acknowledge. It’s also
possible that using postal codes to assess income may have led to
some instances where income levels were inflated or underestimated,
the authors note.
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It’s possible that black patients living in affluent areas don’t
fare as well as white patients because they don’t have the same
amount of social support from their peers, said Dr. Joaquin Cigarroa,
a cardiovascular medicine researcher at Oregon Health & Science
University in Portland.
In poor neighborhoods, black patients may face additional challenges
to surviving a heart attack, added Cigarroa, who wasn’t involved in
the study.
“They more often live in low socioeconomic segments of our community
that often have less access to health care resources and less access
to stores with good nutrition,” Cigarroa said by email. “In
addition, these segments of our community are often not ideally
configured for promoting physical activity with parks, sidewalks,
bike lanes, etc.”
The study findings highlight a need to improve outcomes among poor
and black patients and suggest some differences in heart attack
survival may come down to disparities in quality of care, said
senior study author Dr. Harlan Krumholz of Yale University School of
Medicine in New Haven, Connecticut.
Because black patients have a greater burden of heart disease than
white people, doctors may also need to focus more on prevention in
this community, Krumholz said by email.
“Healthy heart habits may be even more important for
African-Americans, for whom avoiding a heart attack is even more
important given their worse outcomes after the event,” Krumholz
said.
SOURCE: http://bit.ly/1q3uqj1 Circulation, online September 14,
2015.
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