ST-elevation myocardial infarction (STEMI) is a form of heart attack that primarily affects the lower chambers of the heart and can be more severe and dangerous than other types of heart attacks.

A retrospective investigation reveals that low-income residents hospitalized with ST-elevation myocardial infarction (STEMI) have significantly higher death rates than higher-income individuals. The findings were presented today at SCAI 2022 Scientific Sessions.

Low socioeconomic status has been linked to poor cardiovascular disease clinical outcomes.

STEMI is a form of heart attack that primarily affects the lower chambers of the heart and can be more severe and dangerous than other types of heart attacks.

While studies show a link between income and co-morbidities, nothing is known about the impact of a patient’s income on in-hospital mortality after a STEMI.

The authors identified all adult patients admitted with STEMI and grouped them into four quartiles based on the median household income in the patient’s zip code. There were 184,150 (35.1 percent) low-income residents and 123,815 (19.4 percent) high-income residents among the 639,300 STEMI hospitalizations.

The study’s results are:

• In comparison to the highest income residents, the lowest income residents had higher all-cause mortality, duration of stay, rate of invasive mechanical ventilation, and lower inflation-adjusted cost. The lowest-income residents died at a rate of 11.8 percent, while the highest-income individuals died at a rate of 10.4 percent.
• Age: Residents with the lowest incomes tended to be younger (mean age of 63.5) than those with the highest incomes (mean age of 65.7).
• Gender: There were more women in the group with the lowest income (35.7 percent) than in the group with the highest income (29.8 percent ).
• Race/Ethnicity: In comparison to the other groups, low-income residents had the highest number of black, Hispanic, and Native American patients and the lowest proportion of white, Asian, and Pacific Islander patients.
• Location: In comparison to other categories, the highest income residents had more hospitalizations in urban hospitals, while the lowest income residents had more hospitalizations in rural hospitals.
• Cost Per Hospitalization: While the mortality rate for low-income households was greater, the cost per hospitalization was lower ($26,503 vs. $30,540 for high-income persons).

ICD codes were used to identify STEMI patients in a retrospective examination of adult discharges from the National Inpatient Sample (NIS) between 2016 and 2018. The median household income of the zip code where the patient lived was used to divide the patients into quartiles. Several patient- and hospital-level factors were factored into the study models. To represent national estimates, prevalence estimates were weighted using NIS-provided discharge-level weights.

This study emphasizes the rising need to reduce the health inequalities divide that disproportionately affects low-income patients, said Abdul Mannan Khan Minhas, the study’s principal researcher.

“As physicians, it’s imperative that we help everyone get access to high-quality medical care and look with a broader lens at the social and economic factors that could contribute to stark differences in outcomes,” he said.

According to the authors, more study is needed to determine the cause of health disparities in order to inform policy and public health initiatives.

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