Marginalized Neighborhood Linked With Poor AMI Outcomes
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.'
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Yahoo
13 hours ago
- Yahoo
Scientists make alarming discovery after attaching GoPro cameras to polar bears in the Arctic — here's what's happening
Scientists make alarming discovery after attaching GoPro cameras to polar bears in the Arctic — here's what's happening The large amounts of melting sea ice due to rising global temperatures are impacting polar bears' ability to hunt for seals, forcing them to adapt to new ways of finding food. However, these alternative food options are much less nutritious and scarce, resulting in cases of alarming weight loss, Glass Almanac reported. What's happening? A group of Canadian scientists attached GoPro cameras to GPS collars on 20 polar bears in the Hudson Bay area in northeastern Canada. The scientists studied the footage and observed how polar bears are adapting to rapidly melting sea ice. Over three years, the scientists observed how polar bears are collectively losing an alarming amount of weight. Of the 20 bears studied, 19 lost an average of 46 pounds over three weeks, according to Glass Almanac. The loss of sea ice directly affects the bears' ability to hunt for seals, an important food source that provides the bears with high-fat food for energy and warmth, allowing the bears to weather the cold, hunt for more food, and survive. The footage shows the polar bears increasingly turning to food on land as hunting for seals becomes more difficult. On average, polar bears "now spend up to three weeks more on land each year compared to the early 1980s, when the ice was more stable and reliable for hunting," per the Glass Almanac. However, food on land — bird carcasses, berries, and other marine animals — does not provide the bears with enough nutrition to continue hunting and survive, leading to alarming rates of weight loss. Why is melting sea ice concerning? Rising global temperatures are melting sea ice rapidly, which contributes to rising sea levels. This can endanger coastal cities, putting them at risk of flooding or storm surges, and threatening the destruction of coastal infrastructure. Increased global temperatures are also causing more water to evaporate, making extreme weather conditions, like heavy rains, winds, and storms, more frequent and intense. New Mexico, a traditionally dry climate, has been experiencing heavy rainfall and flooding — as many states have recently. Do you worry about air pollution in your town? All the time Often Only sometimes Never Click your choice to see results and speak your mind. What's being done about rising sea levels? Slowing the rate of global temperature increase can help keep sea levels at a safer level, mitigating the incidence and risk of extreme weather events. It also prevents sea ice from disappearing, allowing polar bears to continue hunting for food as they've done for generations. On an individual level, you can effect change by educating yourself, family, and friends about critical climate issues and voting for climate-conscious leaders that put the health of the community and the planet at the forefront of their legislative efforts. In a similar vein, find local organizations doing good and important work, and volunteer your time, money, or effort to support your community and the larger planet's climate resiliency. Each effort toward a healthier, more sustainable planet helps preserve the health and natural beauty of the world, ensuring future generations may get to live and experience the planet as we once did. Join our free newsletter for good news and useful tips, and don't miss this cool list of easy ways to help yourself while helping the planet. Solve the daily Crossword
Yahoo
15 hours ago
- Yahoo
Scientists create ultra-repellent non-stick coating for safer cooking at home
Teflon and other PFAS (per- and polyfluoroalkyl substances) have long been prized for making cookware, packaging, and fabrics resistant to water and grease. But these 'forever chemicals' don't break down in nature and tend to accumulate in the human body, posing serious health and environmental risks. Now, researchers at the University of Toronto have created a promising alternative that delivers high performance with much lower risk. Their new coating repels water and oil as effectively as standard non-stick materials, but contains only trace amounts of the least harmful PFAS variant. Silicone base with PFAS twist The team used polydimethylsiloxane (PDMS), commonly known as silicone, as the base for their new material. 'PDMS is often sold under the name silicone, and depending on how it's formulated, it can be very biocompatible — in fact it's often used in devices that are meant to be implanted into the body,' said Professor Kevin Golovin, who leads the Durable Repellent Engineered Advanced Materials (DREAM) Lab. However, PDMS on its own falls short of matching PFAS when it comes to repelling oil and grease. The breakthrough came when PhD student Samuel Au developed a method to enhance the material's performance through what the team calls nanoscale fletching. Nanoscale fletching for repellency 'Unlike typical silicone, we bond short chains of PDMS to a base material — you can think of them like bristles on a brush,' Au explained. To improve their oil-repelling power, the team added the shortest possible PFAS molecule, consisting of a single carbon atom bonded to three fluorine atoms, to the tips of those bristles. 'If you were able to shrink down to the nanometre scale, it would look a bit like the feathers that you see around the back end of an arrow, where it notches to the bow. That's called fletching, so this is nanoscale fletching.' When the researchers tested the coated fabric with oil droplets, the material achieved a grade of 6 on a standard repellency scale used by the American Association of Textile Chemists and Colorists. That's on par with many commercial PFAS-based coatings. Low risk, commercial potential 'While we did use a PFAS molecule in this process, it is the shortest possible one and therefore does not bioaccumulate,' said Golovin. 'What we've seen in the literature, and even in the regulations, is that it's the longest-chain PFAS that are getting banned first, with the shorter ones considered much less harmful.' 'Our hybrid material provides the same performance as what had been achieved with long-chain PFAS, but with greatly reduced risk.' The team hopes to collaborate with manufacturers to scale up the process and bring the product to market. Meanwhile, research continues. 'The holy grail of this field would be a substance that outperforms Teflon, but with no PFAS at all,' Golovin said. 'We're not quite there yet, but this is an important step in the right direction.' The study is published in the journal Nature Communications. Solve the daily Crossword
Associated Press
15 hours ago
- Associated Press
FROM THE ALZHEIMER'S ASSOCIATION INTERNATIONAL CONFERENCE 2025: DECADES-OLD LEAD POLLUTION LINKED TO MEMORY PROBLEMS IN OLDER ADULTS, STUDY FINDS
Key Takeaways TORONTO, July 27, 2025 /PRNewswire/ -- Historic lead levels from the era of leaded gasoline may be contributing to cognitive issues 50 years later, suggests research reported for the first time at the Alzheimer's Association International Conference ® 2025 (AAIC®), in Toronto and online. Americans are about 20% more likely to experience memory problems if they lived in areas with high levels of atmospheric lead between 1960 and 1974, according to the analysis of more than 600,000 adults 65 and older. ' Research suggests half the U.S. population — more than 170 million people — were exposed to high lead levels in early childhood. This research sheds more light on the toxicity of lead related to brain health in older adults today,' said Maria C. Carrillo, Ph.D., Alzheimer's Association chief science officer and medical affairs lead. 'Other studies reported at AAIC 2025 suggest that (a) lead exposure at any point in life may cause cognitive problems, (b) it may be more likely to affect certain populations and reflect disparities, and (c) there is a biological connection between lead exposure and Alzheimer's.' Historic levels of lead air pollution are associated with memory problems 50 years later In a first-of-its-kind study, researchers examined how exposure to airborne lead from 1960-1974 — when leaded gasoline use was at its highest — may affect brain health later in life. They determined that older adults who grew up in areas with moderate to extremely high historical atmospheric lead levels (HALL) were about 20% more likely to report memory problems as adults 50 years later. The researchers calculated the average HALL by area and linked it to self-reported memory problems from the American Community Survey from 2012-2017 (368,208 people) and 2018-2021 (276,476 people). They didn't analyze the source of the lead but believe that the higher the density of automobile traffic, such as in urban areas, the higher the atmospheric lead. Factoring in both time periods, the researchers determined that 17-22% of people living in areas with moderate, high or extremely high atmospheric lead reported memory issues. 'Our study may help us understand the pathways that contribute to some people developing dementia and Alzheimer's disease,' said Eric Brown, M.D., MSc, FRCPC, lead author of the study, associate scientist and associate chief of geriatric psychiatry at the Centre for Addiction and Mental Health, Toronto. Lead was originally added to gasoline to increase performance until researchers determined it posed serious risks to health and the environment. The more than 20-year-long phase-out of leaded gas began in 1975 when all new cars sold in the U.S. were required to have catalytic converters. 'When I was a child in 1976, our blood carried 15 times more lead than children's blood today,' said Esme Fuller-Thomson, Ph.D., senior author of the study and a professor at the University of Toronto's Factor-Ientash Faculty of Social Work and director of the Institute for Life Course and Aging. 'An astonishing 88% of us had levels higher than 10 micrograms per deciliter, which are now considered dangerously high.' While the risk of atmospheric lead has decreased, other sources of exposure remain, such as old lead paint and pipes. Those who have been exposed to atmospheric lead should focus on reducing other risk factors for dementia, including high blood pressure, smoking and social isolation, said Brown. Living near lead-polluting sites may affect memory Another study reported at AAIC found that older adults who live about three miles from a lead-releasing facility — such as glass, ready-mixed concrete or computer and electronics manufacturers — are more likely to have memory and thinking problems than those who live farther away. This research, which focused on a racially and ethnically diverse group of older adults, reinforces concerns about the long-term cognitive impact of environmental lead exposure, especially in communities already facing health disparities. Researchers assessed 2,379 patients (average age ~74 years) from two studies: the Kaiser Health Aging and Diverse Life Experienced study (KHANDLE, 1,638 patients) of a diverse group of Kaiser Permanente insurance plan members who live in northern California, and the Study of Healthy Aging in African Americans (STAR, 741 patients) study of Black adults age 50 and older who live in the San Francisco and Sacramento areas. They evaluated the participants' proximity to the nearest lead-releasing facility and compared the distance to participants' Neuropsychological Assessment Scales results at baseline and two years later. Compared to two years earlier, the KHANDLE participants who lived within 5 km (just over three miles) of a lead-releasing facility scored 0.15 times lower on verbal episodic memory tests (recall of personal experiences), and 0.07 times lower on overall cognitive ability compared to those living farther away. Every 5 km farther a participant lived from a lead-releasing facility was associated with 5% higher memory scores two years later. Among STAR group participants living within 5 km of a lead-releasing facility, researchers observed a 0.20 times lower score on semantic memory (general knowledge) two years later, compared to those who lived farther away. 'Our results indicate that lead exposure in adulthood could contribute to worse cognitive performance within a few years,' said Kathryn Conlon, Ph.D., MPH, senior author and associate professor of environmental epidemiology, School of Medicine, University of California, Davis. 'Despite tremendous progress on lead abatement, studies have shown there is no safe level of exposure, and half of U.S. children have detectable levels of lead in their blood. Additionally, there are regions and neighborhoods that have more exposure.' According to Conlon, there were 7,507 lead-releasing facilities in the U.S. in 2023. To reduce exposure, Conlon said people living near lead-producing facilities should keep their homes clean to avoid the accumulation of lead-contaminated dust, remove their shoes when coming inside, and place dust mats inside and outside to avoid tracking lead-contaminated dust indoors. Use the Environmental Protection Agency's TRI Toxics Tracker to identify lead-releasing facilities near you. Study reveals how lead exposure may set the stage for Alzheimer's Even low levels of lead exposure can create permanent changes in brain cells, including increased buildup of abnormal tau and amyloid beta, which are proteins associated with Alzheimer's, suggests a third study reported at AAIC 2025. The researchers exposed human brain cells to lead concentrations of zero, 15 and 50 parts per billion (ppb), simulating the kind of lead exposure people might experience through contaminated water or air. The EPA's action level for lead in drinking water is 15 ppb. They ran molecular, genetic, biochemical and functional tests on the cells and determined that (a) the 15-ppb and 50-ppb lead-exposed neurons were more electrically active (suggesting early dysfunction) than those that had no exposure, (b) energy-producing cells were damaged, and (c) there was an increase in tau and amyloid beta. Even after the lead was removed, the cells remained primed for damage, responding more severely to additional stressors such as tau. 'These findings help explain how lead exposure, especially in early life or from occupational and environmental sources, might leave a lasting molecular imprint on the brain making it more vulnerable to age-related diseases like Alzheimer's,' said Junkai Xie, Ph.D., lead author of the study and post-doctoral research associate in chemical engineering at Purdue University. 'Our results show that lead exposure isn't just a short-term concern; it may set the stage for cognitive problems decades later.' About the Alzheimer's Association International Conference® (AAIC®) The Alzheimer's Association International Conference (AAIC) is the world's largest gathering of researchers from around the world focused on Alzheimer's and other dementias. As a part of the Alzheimer's Association's research program, AAIC serves as a catalyst for generating new knowledge about dementia and fostering a vital, collegial research community. AAIC 2025 home page: AAIC 2025 newsroom: AAIC 2025 hashtag: #AAIC25 About the Alzheimer's Association® The Alzheimer's Association is a worldwide voluntary health organization dedicated to Alzheimer's care, support and research. Our mission is to lead the way to end Alzheimer's and all other dementia — by accelerating global research, driving risk reduction and early detection, and maximizing quality care and support. Our vision is a world without Alzheimer's and all other dementia®. Visit or call 800.272.3900. View original content to download multimedia: SOURCE Alzheimer's Association
