Heart attack deaths among poor tied to age

NEW YORK (Reuters Health) - Even in Canada where everyone has medical coverage, a "wealth-health gradient" in mortality rates from heart disease exists among different income groups. Now, results of a new study suggest that older age and more extensive cardiovascular risk factors -- and not sub-par treatment -- explain why poor people have higher mortality rates than affluent people after suffering a heart attack.

"Previous studies in Canada and elsewhere have shown that socioeconomic factors are important markers of mortality after MI, but we don't know why," lead investigator Dr. David A. Alter told Reuters Health.

"Is it because less affluent patients are sicker with more cardiovascular risk factors when they come in with a heart attack, or is it the way we treat patients?" he explained. "Do we treat them inequitably, with less intensive care?"

To probe the factors that account for disparities in outcomes, Dr. Alter, from the Institute for Clinical Evaluative Sciences in Toronto, and his associates profiled 3138 patients admitted to hospitals in Ontario for treatment of a hearty attack.

Patients with the lowest income were twice as likely as those with the highest to die before scheduled follow-up at 30 days, 1 year, and 2 years, the investigators report in the Annals of Internal Medicine.

"Differences in mortality between poorer and more affluent patients were virtually entirely explained by age and differences in cardiovascular risk profile upon hospital presentation," Dr. Alter said.

"While there were disparities between lower and higher income patients in the type of care that we provided," he added, "those factors were not important players in explaining the survival differences."

He also pointed out that it's not too late to address cardiovascular risk factors once someone has a heart attack.

"Cardiac rehabilitation initiatives that encompass exercise, obesity, smoking cessation, and nutritional status have a huge impact on survival rates after heart attack," he said.

"The problem," he explained, is that, "in our country there is a huge discrepancy in funding for prevention initiatives when compared to amount of resources spent on technology, such as angioplasty and angiography. "

For example, "In Ontario alone we are spending over $400 million for investigation and treatment of coronary disease," he noted. "By contrast, the funding purse for cardiac rehabilitation is under $10 million."

So, when it comes to the health-wealth gap, he concluded, "If we are ever going to make a dent in differential survival rates we'll need to attend to this discrepancy" in funding for treatment versus prevention.

SOURCE: Annals of Internal Medicine, January 17, 2006.