logo
Marginalized Neighborhood Linked With Poor AMI Outcomes

Marginalized Neighborhood Linked With Poor AMI Outcomes

Medscape15-07-2025
Neighborhood marginalization is associated with increased risks for mortality and hospitalization in young survivors of acute myocardial infarction (AMI), according to a Canadian study.
The population-based, retrospective cohort study involving 65,464 Ontario patients younger than 65 years who survived AMI found that those in the most marginalized quintile had significantly greater hazards of all-cause death over 30 days (hazard ratio [HR], 2.43) and hospitalization from all causes (HR, 1.16) but not recurrent AMI.
'You're two and a half more times more likely to die within 30 days if you live in a marginalized neighborhood compared with the least marginalized neighborhood,' study author Leo E. Akioyamen, MD, a resident in internal medicine at the University of Toronto, Toronto, told Medscape Medical News. 'It is pretty striking.'
The study was published online on July 2 in JAMA Network Open .
Sociodemographics and Outcomes
'We took a population of younger adults and designed a study in which we took a look at what happened to them when they went back to the neighborhoods they came from,' said Akioyamen. 'We followed them for up to 3 years, and we essentially controlled for all the variables that we typically think account for most of the socioeconomic differences in outcomes.'
The patients included in the analysis underwent invasive evaluation between April 2010 and March 2019. Eligible participants survived for at least 7 days after hospital discharge. The study population had a median age of 56 years, and 22.9% of participants were women.
One year following the index AMI, patients in the most marginalized neighborhood experienced the highest risk for all-cause death (adjusted HR [AHR], 1.80) and hospitalization from all causes (AHR, 1.20).
Investigators observed that the differences in outcomes persisted at 3 years after discharge. Mortality rates ranged from 2.2% in the least marginalized neighborhood quintile to 5.2% in the most marginalized neighborhood quintile.
Three years following the first AMI hospitalization, the risk for all-cause death rose with increasing marginalization (second quintile: AHR, 1.13; third quintile: AHR, 1.25; fourth quintile: AHR, 1.35; fifth quintile: AHR, 1.52). Over 3 years, patients in the most marginalized quintile also had a greater risk for hospitalization from all causes (AHR, 1.21) and AMI (AHR, 1.20).
'What we also observed were gradients ,' said Akioyamen. 'We showed that with increasing neighborhood marginalization, we saw increasing risks of death and other bad outcomes such as heart attacks and hospitalizations.'
The authors also observed a care gap over a 1-year period, in which patients living in the least marginalized neighborhoods vs those living in the most marginalized neighborhoods had greater contact with primary care physicians (96.1% vs 91.6%) and cardiologists (88.0% vs 75.7%).
Prospective Analysis Needed
Commenting on the findings for Medscape Medical News , Dipti Itchhaporia, MD, Eric and Sheila Samson Endowed Chair in Cardiovascular Health at the University of California, Irvine, pointed out that the study probes a challenging question.
'It's a provocative study, but I am not sure it's completely generalizable,' she said. 'It certainly would benefit from further research into a more vigorous study design. Even though the study uses a large, robust dataset, there could still be missing data or unmeasured confounding variables that can affect the findings.'
Lifestyle data such as diet and exercise are not captured through the study design, nor are variables like family history. 'We come away knowing these patients are not doing well, but I'm not sure we come away with the answer as to why, exactly,' said Itchhaporia. Prospective study designs might uncover unknown variables that affect outcomes. 'We need more studies to really be able to drill down to see what would be important to know.'
Cost No Barrier
The findings indicate that barriers other than cost and insurance status are affecting health outcomes of this patient population, Miles Marchand, MD, clinical assistant professor of cardiology at the University of British Columbia in Vancouver, told Medscape Medical News.
'The real novelty and importance of this study is that it is performed in a country with universal healthcare coverage,' said Marchand. 'In this healthcare environment, disparate health outcomes cannot be explained solely by financial differences in access to care; other contributing factors may be at play.'
Marchand commended the authors for using a robust study sample but agreed that the causal factors remain unknown. 'One of the [study's] main strengths is its use of large database linkages, resulting in a large cohort size,' he said. 'One of the key limitations is that we don't know the exact reason for disparities between neighborhoods. Why is it that a more marginalized neighborhood is at higher risk than a less marginalized neighborhood? This study is not able to answer that question.'
Orange background

Try Our AI Features

Explore what Daily8 AI can do for you:

Comments

No comments yet...

Related Articles

Air quality alert in New York City area due to smoke from Canada wildfires
Air quality alert in New York City area due to smoke from Canada wildfires

CBS News

timean hour ago

  • CBS News

Air quality alert in New York City area due to smoke from Canada wildfires

An air quality alert was issued by the New York State Department of Health on Saturday due to smoke from wildfires in Canada. The air quality health advisory covers New York City and the surrounding metropolitan area, including Long Island, as well as the Lower Hudson Valley, Upper Hudson Valley and the Adirondacks. The advisory went into effect at noon and expires at midnight. Today is another hot day in the Tri-State Area and more storms could hit the region Sunday. New York says the air quality forecast is "unhealthy for sensitive groups" Saturday. According to the National Weather Service, the air quality index (AQI) is predicted to be greater than 100, and could even reach up to 135 in NYC, which indicates a greater health concern due to fine particles in the air. Put plainly, the AQI helps measure the severity of air pollution and categorizes the health risks. The higher the number, the greater the risk. "People who may be especially sensitive to the effects of elevated levels of pollutants include the very young, and those with preexisting respiratory problems such as asthma or heart disease. Those with symptoms should consider consulting their personal physician," the NWS alert says. New York health officials recommend limiting strenuous outdoor activities to reduce the risk of adverse health effects when there are elevated levels of pollution, according to the NWS.

Wildfire smoke chokes northern Manitoba air, while hot, humid weather plagues the south
Wildfire smoke chokes northern Manitoba air, while hot, humid weather plagues the south

Yahoo

time3 hours ago

  • Yahoo

Wildfire smoke chokes northern Manitoba air, while hot, humid weather plagues the south

As a large swath of Manitoba deals with heavy wildfire smoke polluting the air, others in the province are starting the weekend amidst suffocating heat and humid conditions. Environment and Climate Change Canada has issued an air quality warning for much of northern Manitoba including Thompson, The Pas and Flin Flon on Saturday morning. With relatively light winds, smoke is expected to concentrate especially over the area near active wildfires, causing poor air quality and reduced visibility throughout the day. Everyone's health is at risk, regardless of age or health status, during heavy smoke conditions, the federal agency said. But pregnant people, children, seniors and those with underlying health conditions are more likely to be impacted. Environment Canada is advising people to reschedule or cancel outdoor sports and activities. People who work outdoors should avoid extraneous activities and seek medical attention if experiencing symptoms. Those may include eye eye, nose and throat irritation, headaches or a mild cough. More less common symptoms include wheezing, chest pains or severe cough, Environment Canada said. According to the province's latest fire bulletin, issued Friday, the Manitoba Wildfire Service was responding to 121 active wildfires across the province, which has seen a total of 337 wildfires to date, well above the average for this time of year of 260. Heat warning Meanwhile, pockets of southern Manitoba, including the cities of Winnipeg, Brandon and Portage la Prairie, are under a heat warning. Humid and hot conditions are expected to remain throughout Saturday with temperatures reaching the low 30's C and humidex values nearing 38, Environment Canada said. Conditions are expected to improve with a cold front moving overnight Saturday, but in the meantime the weather agency is advising people to watch for signs of early heat exhaustion including headache, dizziness and intense fatigue. Extreme heat can affect everyone's health, but the risks are greater for older adults and other vulnerable people, Environment Canada said. To reduce the health effects of heat, stay out of direct sunlight, drink plenty of water and stay in a cool space, closing blinds and open windows if it is cooler outside than inside or turning on air conditioning. The weather agency also advises people to ensure children and pets are never left alone in closed vehicles.

This 'super-Earth' exoplanet 35 light-years away might have what it takes to support life
This 'super-Earth' exoplanet 35 light-years away might have what it takes to support life

Yahoo

time4 hours ago

  • Yahoo

This 'super-Earth' exoplanet 35 light-years away might have what it takes to support life

When you buy through links on our articles, Future and its syndication partners may earn a commission. A fifth planet has been detected within the habitable zone of a neighboring star, where conditions could perhaps support liquid water and potentially life. Located about 35 light-years from Earth, L 98-59 is a cool, dim red dwarf star already known to host a compact system of small, rocky planets. The latest discovery, led by researchers at the Université de Montréal's Trottier Institute for Research on Exoplanets, confirms the presence of L 98-59 f, a super-Earth with a minimum mass 2.8 times that of our planet. The newly discovered exoplanet follows an almost perfectly circular 23-Earth-day orbit around its star. The world receives roughly the same amount of stellar energy as Earth, placing it in the star's habitable zone — a range of distances where liquid water could exist under suitable atmospheric conditions, according to a statement from the university. "Finding a temperate planet in such a compact system makes this discovery particularly exciting," Charles Cadieux, a postdoctoral researcher at the university and lead author of the study, said in the statement. "It highlights the remarkable diversity of exoplanetary systems and strengthens the case for studying potentially habitable worlds around low-mass stars." L 98-59 f was discovered by reanalyzing data from the European Southern Observatory's (ESO) HARPS (High Accuracy Radial velocity Planet Searcher) and ESPRESSO (Echelle Spectrograph for Rocky Exoplanet and Stable Spectroscopic Observations) spectrographs. Since the exoplanet doesn't transit, or pass in front of, its host star from our perspective, astronomers spotted it by tracking subtle shifts in the star's motion that are caused by the planet's gravitational pull. By combining the spectrograph data with observations from NASA's TESS (Transiting Exoplanet Survey Satellite) and James Webb Space Telescope (JWST) — and using advanced techniques to filter out stellar noise — researchers were able to determine the size, mass and key properties of all five planets. The study shows that L 98-59 b, the innermost planet, is just 84% the size of Earth and half its mass, making it one of the smallest exoplanets measured. Tidal forces may drive volcanic activity on the system's two innermost planets, while the third's unusually low density suggests it could be a water-rich world unlike any in our solar system. This diversity offers a rare opportunity to investigate the formation and evolution of planetary systems beyond our own, team members said. RELATED STORIES — Exoplanets: Everything you need to know about the worlds beyond our solar system — Nearby exoplanet could offer clues about atmospheres around hot, rocky alien worlds — Goldilocks zone: Everything you need to know about the habitable sweet spot "These new results paint the most complete picture we've ever had of the fascinating L 98-59 system," Cadieux said. "It's a powerful demonstration of what we can achieve by combining data from space telescopes and high-precision instruments on Earth, and it gives us key targets for future atmospheric studies with the James Webb Space Telescope." Because L 98-59 is small and nearby, its planets are especially well-suited for follow-up atmospheric studies. If L 98-59 f has an atmosphere, telescopes like JWST may be able to detect water vapor, carbon dioxide — or even biosignatures. The new study was published July 12 in the journal Earth and Planetary Astrophysics. Solve the daily Crossword

DOWNLOAD THE APP

Get Started Now: Download the App

Ready to dive into a world of global content with local flavor? Download Daily8 app today from your preferred app store and start exploring.
app-storeplay-store