Neighborhood income, health insurance, and prehospital delay for myocardial infarction: The atherosclerosis risk in communities study

Randi E. Foraker, Kathryn M. Rose, Aileen P. McGinn, Chirayath M. Suchindran, David C. Goff, Eric A. Whitsel, Joy L. Wood, Wayne D. Rosamond

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Background: Outcomes following an acute myocardial infarction (AMI) are generally more favorable if prehospital delay time is minimized. Methods: We examined the association of neighborhood household income (nINC) and health insurance status with prehospital delay among a weighted sample of 9700 men and women with a validated, definite, or probable AMI in the Atherosclerosis Risk in Communities (ARIC) community surveillance study (1993-2002). Weighted multinomial regression with generalized estimation equations was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) and to account for the clustering of patients within census tracts. Results: Low nINC was associated with a higher odds of long vs short delay (OR, 1.46; 95% CI, 1.09-1.96) and medium vs short delay (OR, 1.43; 95% CI, 1.12-1.81) compared with high nINC in a model including age, sex, race, diabetes, hypertension, presence of chest pain, arrival at the hospital via emergency medical service, distance from residence to hospital, study community, and year of AMI event. Meanwhile, compared with patients with prepaid insurance or prepaid plus Medicare, patients with Medicaid were more likely to have a long vs short delay (OR, 1.87; 95% CI, 1.10-3.19) and a medium vs short delay (OR, 1.76; 95% CI, 1.13-2.74). Conclusions: Both low nINC and being a Medicaid recipient are associated with longer prehospital delay. Reducing socioeconomic and insurance disparities in prehospital delay is critical because excess delay time may hinder effective care for AMI.

Original languageEnglish (US)
Pages (from-to)1874-1879
Number of pages6
JournalArchives of Internal Medicine
Volume168
Issue number17
DOIs
StatePublished - Sep 22 2008

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Health Insurance
Atherosclerosis
Myocardial Infarction
Odds Ratio
Confidence Intervals
Medicaid
Insurance
Insurance Coverage
Emergency Medical Services
Censuses
Medicare
Chest Pain
Health Status
Cluster Analysis
Hypertension

ASJC Scopus subject areas

  • Internal Medicine

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Neighborhood income, health insurance, and prehospital delay for myocardial infarction : The atherosclerosis risk in communities study. / Foraker, Randi E.; Rose, Kathryn M.; McGinn, Aileen P.; Suchindran, Chirayath M.; Goff, David C.; Whitsel, Eric A.; Wood, Joy L.; Rosamond, Wayne D.

In: Archives of Internal Medicine, Vol. 168, No. 17, 22.09.2008, p. 1874-1879.

Research output: Contribution to journalArticle

Foraker, Randi E. ; Rose, Kathryn M. ; McGinn, Aileen P. ; Suchindran, Chirayath M. ; Goff, David C. ; Whitsel, Eric A. ; Wood, Joy L. ; Rosamond, Wayne D. / Neighborhood income, health insurance, and prehospital delay for myocardial infarction : The atherosclerosis risk in communities study. In: Archives of Internal Medicine. 2008 ; Vol. 168, No. 17. pp. 1874-1879.
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abstract = "Background: Outcomes following an acute myocardial infarction (AMI) are generally more favorable if prehospital delay time is minimized. Methods: We examined the association of neighborhood household income (nINC) and health insurance status with prehospital delay among a weighted sample of 9700 men and women with a validated, definite, or probable AMI in the Atherosclerosis Risk in Communities (ARIC) community surveillance study (1993-2002). Weighted multinomial regression with generalized estimation equations was used to estimate odds ratios (ORs) and 95{\%} confidence intervals (CIs) and to account for the clustering of patients within census tracts. Results: Low nINC was associated with a higher odds of long vs short delay (OR, 1.46; 95{\%} CI, 1.09-1.96) and medium vs short delay (OR, 1.43; 95{\%} CI, 1.12-1.81) compared with high nINC in a model including age, sex, race, diabetes, hypertension, presence of chest pain, arrival at the hospital via emergency medical service, distance from residence to hospital, study community, and year of AMI event. Meanwhile, compared with patients with prepaid insurance or prepaid plus Medicare, patients with Medicaid were more likely to have a long vs short delay (OR, 1.87; 95{\%} CI, 1.10-3.19) and a medium vs short delay (OR, 1.76; 95{\%} CI, 1.13-2.74). Conclusions: Both low nINC and being a Medicaid recipient are associated with longer prehospital delay. Reducing socioeconomic and insurance disparities in prehospital delay is critical because excess delay time may hinder effective care for AMI.",
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AU - McGinn, Aileen P.

AU - Suchindran, Chirayath M.

AU - Goff, David C.

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N2 - Background: Outcomes following an acute myocardial infarction (AMI) are generally more favorable if prehospital delay time is minimized. Methods: We examined the association of neighborhood household income (nINC) and health insurance status with prehospital delay among a weighted sample of 9700 men and women with a validated, definite, or probable AMI in the Atherosclerosis Risk in Communities (ARIC) community surveillance study (1993-2002). Weighted multinomial regression with generalized estimation equations was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) and to account for the clustering of patients within census tracts. Results: Low nINC was associated with a higher odds of long vs short delay (OR, 1.46; 95% CI, 1.09-1.96) and medium vs short delay (OR, 1.43; 95% CI, 1.12-1.81) compared with high nINC in a model including age, sex, race, diabetes, hypertension, presence of chest pain, arrival at the hospital via emergency medical service, distance from residence to hospital, study community, and year of AMI event. Meanwhile, compared with patients with prepaid insurance or prepaid plus Medicare, patients with Medicaid were more likely to have a long vs short delay (OR, 1.87; 95% CI, 1.10-3.19) and a medium vs short delay (OR, 1.76; 95% CI, 1.13-2.74). Conclusions: Both low nINC and being a Medicaid recipient are associated with longer prehospital delay. Reducing socioeconomic and insurance disparities in prehospital delay is critical because excess delay time may hinder effective care for AMI.

AB - Background: Outcomes following an acute myocardial infarction (AMI) are generally more favorable if prehospital delay time is minimized. Methods: We examined the association of neighborhood household income (nINC) and health insurance status with prehospital delay among a weighted sample of 9700 men and women with a validated, definite, or probable AMI in the Atherosclerosis Risk in Communities (ARIC) community surveillance study (1993-2002). Weighted multinomial regression with generalized estimation equations was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) and to account for the clustering of patients within census tracts. Results: Low nINC was associated with a higher odds of long vs short delay (OR, 1.46; 95% CI, 1.09-1.96) and medium vs short delay (OR, 1.43; 95% CI, 1.12-1.81) compared with high nINC in a model including age, sex, race, diabetes, hypertension, presence of chest pain, arrival at the hospital via emergency medical service, distance from residence to hospital, study community, and year of AMI event. Meanwhile, compared with patients with prepaid insurance or prepaid plus Medicare, patients with Medicaid were more likely to have a long vs short delay (OR, 1.87; 95% CI, 1.10-3.19) and a medium vs short delay (OR, 1.76; 95% CI, 1.13-2.74). Conclusions: Both low nINC and being a Medicaid recipient are associated with longer prehospital delay. Reducing socioeconomic and insurance disparities in prehospital delay is critical because excess delay time may hinder effective care for AMI.

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