Low-income people have higher heart attack death risk than high-income people - Study

Berlinda Entsie 08:16 - 06 April 2023

Person having heart attack

According to the research, lower-income patients with heart attack risk early death than higher-income patients.

Harvard Medical School, the University of Texas Medical Branch, Galveston, ICES (formerly the Institute for Clinical Evaluative Sciences), and other international collaborators' research has shown that low-income patients across six different countries have mortality rates 10 to 20 per cent greater than their high-income peers.

The findings suggest that income-based disparities are present even in countries with universal health care and robust social services, the researchers said.

The paper, published in the journal JAMA, was a project of the International Health System Research Collaborative, an effort dedicated to understanding the trade-offs inherent in different nations’ approaches to delivering health care.

“A country’s health care system can impact treatment and outcomes for specific health conditions, like cardiovascular disease,” said Bruce Landon, professor of health care policy at the Blavatnik Institute at HMS.

“We wanted to explore whether the poorer outcomes that have been observed in lower-income Americans relative to higher-income Americans were reduced in countries with universal health insurance. We found that high-income individuals had better survival rates and were more likely to receive life-saving treatments compared to low-income individuals, regardless of their country of residence or type of health system,” he said.

The authors analyzed population-based health care billing and claim data to study all adults 66 years or older who were hospitalized with a type of heart attack known as ST-elevation myocardial infarction (STEMI), which tends to be more severe, and non-ST-elevation myocardial infarction (NSTEMI).

Outcomes for STEMI and NSTEMI patients with low incomes were compared with outcomes among patients with high incomes in the U.S., Canada (Ontario and Manitoba), England, Netherlands, Taiwan, and Israel between 2013 and 2018. The study included 289,376 patients hospitalized with STEMI and 843,046 patients hospitalized with NSTEMI.

Findings showed that:

Thirty-day mortality following hospitalization generally was 1 to 3 percentage points lower for high-income patients. The largest difference was seen in Canada (14.9 percent and 17.8 percent for high versus low-income individuals with STEMI).
Differences in one-year mortality were even larger, with the highest difference in Israel (16.2 percent and 25.3 percent for high versus low-income individuals with STEMI).
Low-income patients in all countries were less likely to receive necessary and aggressive treatments for STEMI, such as cardiac catheterisation and revascularization, and readmission rates to hospitals were higher than for low-income patients.
There were more females in the lowest-income group compared to the highest-income group in all countries.