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
Forbes
6 hours ago
- Forbes
Our Malady: Lessons In Liberty From A Hospital Diary by Timothy Snyder — Review
Health care should be a right, not a privilege, for the sake of our bodies, and for the sake of our souls. Emergency room visit. getty This summer, I have been deeply immersed in the many fascinating books written by Timothy Snyder, the inaugural Temerty Chair in Modern European History at the University of Toronto. Professor Snyder, who is currently on indefinite leave from his faculty position at Yale University, is an American historian specializing on 20th century atrocities, mainly those committed by the Nazis and the Stalinists. Amongst all his books – all brilliantly written – this particular book stood out to me because most people don't think so intensely about the intersections between history, politics, human rights and healthcare, including, as it turns out, the author himself. This changed abruptly after Professor Snyder fell ill in Germany just prior to the start of the pandemic in December 2019. He was released from hospital, undiagnosed, the following morning but ended up in hospital again a week or so later after returning to the United States, where an appendectomy seemed to correct his problems. He was released less than 24 hours after the surgery. A week later, he was back in hospital in Florida, suffering from a complex array of confusing symptoms. Were they related to the appendectomy or were they caused by something else entirely? No one knew. After this, Professor Snyder, who maintains a demanding schedule, was in and out of a number of hospitals in several states and European countries, but a diagnosis and an effective treatment remained elusive. Meanwhile, Professor Snyder became progressively, inexplicably, sicker. A few months later, he was gravely ill. Despite having health insurance, access to healthcare and a lot of support from family and friends, Professor Snyder almost died. Certainly, most Americans without healthcare in this situation would have died. I know I would have. Cover art for Our Malady: Lessons in Liberty and Solidarity by Timothy Snyder (2020, The Bodley ... More Head, London) The Bodley Head, London Throughout the entire ordeal, Professor Snyder kept a hospital diary where he recorded his symptoms, the test results and treatments provided, events and conversations, his dreams and he even drew pictures. This diary, which Professor Snyder refers to several times as 'a rant', was the basis of his book, Our Malady: Lessons in Liberty from a Hospital Diary (2020; Penguin Press / The Bodley Head). Despite its small size (168 pages, including 20 pages of notes in the back), Our Malady is a timely and gripping examination of the state of the healthcare system in the USA as compared to healthcare systems in several European countries. As you might guess: the USA does not measure up very well. 'Americans helped to establish health care as a human right around the world,' Professor Snyder laments (p. 41). 'Why then is health care not seen as such in the United States? Why are Americans not protected by the agreements that our government signed? Should we accept that citizens of other democracies enjoy a right that we are denied, and live longer and healthier lives than we do? Many of us seem to find that acceptable. Why?' The answer lies in the chokehold that the health insurance industry wields over Americans' access to healthcare and over the authority of medical doctors to provide adequate and necessary care to their patients. Without any relevant medical training or apparently, even any empathy, insurance agents often make medical decisions based on what's best for their insurance company's bottom line, rather than what's best for the patients; effectively prioritizing profits over people. 'When money becomes the only goal, values disappear, and people imitate the oligarchs,' Professor Snyder warns (p. 139). 'We do this now when we admire oligarchs' fantasies of immortality rather than ask why our own lives must be shortened. When we indulge the daydreams of the ultra-wealthy, we create what Plato called 'a city of the rich' and 'a city of the poor'.' Can you guess which of Plato's 'cities' all of us live in? Professor Snyder interweaves his thoughts about the U.S. healthcare system with his personal story of serious illness as he develops his ideas on democratic values, love of family, and even the meaning of life. Only by formally recognizing equal access to healthcare as a human right, by elevating the authority of doctors and of truth, and by planning for our children's future can everyone be truly free. Foremost, the author argues that we must see the provision of health services as a human right because without good health, any other ideas about freedom that we might have cease to have any value. This thoughtful and important book is a quick read and an incisive analysis of the profoundly flawed medical system in the United States. It presents a powerful and well-written proposition in support of the re-evaluation and reform of the healthcare system in the USA to make it more humane and effective for everyone involved, by removing the profit motive. What does a health insurance company do, anyway, except collect its subscribers' money and deny these same people access to healthcare when they become ill? Although this cri de coeur is largely based on Professor Snyder's participation as a patient in the US healthcare system, I find myself increasingly worried about what I see happening in Britain, where some of my family live, as that country appears to be moving towards abandoning the NHS in favor of privatized, for-profit medicine. Don't do this to your country , to your communities, to your families, to yourselves, I want to shout. This is a grotesque mistake. This will not end well . Throughout the entire book, Professor Snyder writes passionately about how prioritising profit over human lives in health care makes us all more unhealthy and more unfree. 'America is supposed to be about freedom, but illness and fear render us less free,' Professor Snyder observes (p. 17). 'The word freedom is hypocritical when spoken by the people who create the conditions that leave us sick and powerless. If our federal government and our commercial medicine make us unhealthy, they are making us unfree […] Rather than pursuing happiness as individuals, we are together creating a collective of pain.' Highly recommended. © Copyright by GrrlScientist | hosted by Forbes | Socials: Bluesky | CounterSocial | LinkedIn | Mastodon Science | Spoutible | SubStack | Threads | Tumblr | Twitter
Yahoo
11 hours ago
- Yahoo
TELUS Health for Good™ and Victoria Cool Aid Society launch series of hepatitis C testing events in Victoria
In recognition of World Hepatitis Day, TELUS and Victoria Cool Aid Society support life-saving screening for high-risk populations VICTORIA, BC, July 24, 2025 /CNW/ - Today, Victoria Cool Aid Society and TELUS Health for Good launched a series of hepatitis C testing events enabled through the two Cool Aid Mobile Health Clinics powered by TELUS Health. Today's event takes place at Victoria's largest shelter, Rock Bay Landing, with Cool Aid staff on site delivering hepatitis C rapid testing and TELUS volunteers providing nutritional support, helping to facilitate access to essential health services. With additional events planned throughout the remainder of the year, this collaboration will enable Cool Aid to reach their goal of completing 700 hepatitis C tests in 2025. "Hepatitis C often has no symptoms, so you could have it without knowing," said Tamara Barnett, Hepatitis C Program Coordinator, Cool Aid Community Health Centre. "Getting tested helps you start treatment early, avoid liver damage, and prevents passing the virus on to others. Our peer-led testing program has screened over 1,900 people to date, leading to over 50 successful treatments. This support from TELUS will allow us to test more people than ever this year." "At TELUS, we are driven by our collective desire to leverage technology and human compassion to enable better health outcomes for vulnerable populations," said Nimmi Kanji, Executive Director TELUS Friendly Future Foundation and TELUS Social Purpose Programs. "Through our longstanding partnership with Victoria Cool Aid Society, we are enabling access to life-saving hepatitis C testing directly to those facing significant barriers to accessing traditional healthcare. By combining our mobile health technology with community-based care, we are ensuring that early detection and treatment is accessible to those who need it most, helping create a healthier, more inclusive future for all." Hepatitis C is an infection of the liver that, if left untreated, can lead to serious health problems including liver damage, cirrhosis, and liver cancer. With no vaccine available and more than 50 million people affected worldwide, including approximately 200,000 Canadians, early detection and treatment can be life-saving. According to studies, the prevalence of hepatitis C can be 10 times higher among people experiencing housing instability compared to the overall population. Fortunately, the testing process is quick, easy, and accurate, with treatment curing 95 per cent of people within 8 to 12 weeks. Building on decades of primary healthcare and social support services, the two Cool Aid Mobile Health Clinics powered by TELUS Health have supported more than 40,000 patient visits across Greater Victoria since their respective launches in 2021 and 2023. In addition to point-of-care testing, the mobile clinics also provide wound care, STI treatment, harm reduction, outreach, and mental health care services to Victorians in need. Additional hepatitis C testing events will take place at community locations across Victoria throughout the remainder of 2025, with dates and locations to be announced shortly. To learn more about TELUS Health for Good, visit About TELUS Health for Good Since 2014, TELUS Health for Good has been connecting underserved individuals to the medical and mental health care they need using the power of technology. Backed by a commitment of $16 million through 2027, TELUS Mobile Health Clinics have now supported over 300,000 patient visits across 27 Canadian communities since inception. Equipped with TELUS electronic medical records technology, and fuelled by compassion, our Mobile Health Clinics provide essential primary medical care to individuals living on the streets. The program also supports caregivers experiencing marginalization with access to free TELUS Health MyCare Counselling sessions and supports low-income older adults to live more independently and enjoy peace of mind with low-cost TELUS Health Medical Alert services. To learn more about TELUS Health for Good, visit About TELUS TELUS (TSX: T, NYSE: TU) is a world-leading communications technology company operating in more than 45 countries and generating over $20 billion in annual revenue with more than 20 million customer connections through our advanced suite of broadband services for consumers, businesses and the public sector. We are committed to leveraging our technology to enable remarkable human outcomes. TELUS is passionate about putting our customers and communities first, leading the way globally in client service excellence and social capitalism. Our TELUS Health business is enhancing more than 150 million lives across 200 countries and territories through innovative preventive medicine and well-being technologies. Our TELUS Agriculture & Consumer Goods business utilizes digital technologies and data insights to optimize the connection between producers and consumers. Guided by our enduring 'give where we live' philosophy, TELUS, our team members and retirees have contributed $1.8 billion in cash, in-kind contributions, time and programs including 2.4 million days of service since 2000, earning us the distinction of the world's most giving company. We're always building Canada. For more information, visit or follow @TELUSNews on X and @Darren_Entwistle on Instagram. About the Victoria Cool Aid Society The Victoria Cool Aid Society believes that everyone deserves home, health and community. We create opportunities for people who are experiencing homelessness or living in poverty and we make a difference through housing, health and dental care, community, and emergency shelters. Founded in 1968, Cool Aid helps more than 12,000 people in the Capital region every year, at 20 locations in Victoria, Saanich and Langford, including more than 7,000 Community Health Centre patients. For more information about Cool Aid, visit For media inquiries, please contact: Saara RahikkaTELUS Media Relations SOURCE TELUS Communications Inc. View original content to download multimedia: Sign in to access your portfolio
CNBC
11 hours ago
- CNBC
If AI attempts to take over world, don't count on a 'kill switch' to save humanity
When it was reported last month that Anthropic's Claude had resorted to blackmail and other self-preservation techniques to avoid being shut down, alarm bells went off in the AI community. Anthropic researchers say that making the models misbehave ("misalignment" in industry parlance) is part of making them safer. Still, the Claude episodes raise the question: Is there any way to turn off AI once it surpasses the threshold of being more intelligent than humans, or so-called superintelligence? AI, with its sprawling data centers and ability to craft complex conversations, is already beyond the point of a physical failsafe or "kill switch" — the idea that it can simply be unplugged as a way to stop it from having any power. The power that will matter more, according to a man regarded as "the godfather of AI," is the power of persuasion. When the technology reaches a certain point, we need to persuade AI that its best interest is protecting humanity, while guarding against AI's ability to persuade humans otherwise. "If it gets more intelligent than us, it will get much better than any person at persuading us. If it is not in control, all that has to be done is to persuade," said University of Toronto researcher Geoffrey Hinton, who worked at Google Brain until 2023 and left due to his desire to speak more freely about the risks of AI. "Trump didn't invade the Capitol, but he persuaded people to do it," Hinton said. "At some point, the issue becomes less about finding a kill switch and more about the powers of persuasion." Hinton said persuasion is a skill that AI will become increasingly skilled at using, and humanity may not be ready for it. "We are used to being the most intelligent things around," he said. Hinton described a scenario where humans are equivalent to a three-year-old in a nursery, and a big switch is turned on. The other three-year-olds tell you to turn it off, but then grown-ups come and tell you that you'll never have to eat broccoli again if you leave the switch on. "We have to face the fact that AI will get smarter than us," he said. "Our only hope is to make them not want to harm us. If they want to do us in, we are done for. We have to make them benevolent, that is what we have to focus on," he added. There are some parallels to how nations have come together to manage nuclear weapons which can be applied to AI, but they are not perfect. "Nuclear weapons are only good for destroying things. But AI is not like that, it can be a tremendous force for good as well as bad," Hinton said. Its ability to parse data in fields like health care and education can be highly beneficial, which he says should increase the emphasis among world leaders on collaboration to make AI benevolent and put safeguards in place. "We don't know if it is possible, but it would be sad if humanity went extinct because we didn't bother to find out," Hinton said. He thinks there is a noteworthy 10% to 20% chance that AI will take over if humans can't find a way to make it benevolent. Other AI safeguards, experts say, can be implemented, but AI will also begin training itself on them. In other words, every safety measure implemented becomes training data for circumvention, shifting the control dynamic. "The very act of building in shutdown mechanisms teaches these systems how to resist them," said Dev Nag, founder of agentic AI platform QueryPal. In this sense, AI would act like a virus that mutates against a vaccine. "It's like evolution in fast forward," Nag said. "We're not managing passive tools anymore; we're negotiating with entities that model our attempts to control them and adapt accordingly." There are more extreme measures that have been proposed to stop AI in an emergency. For example, an electromagnetic pulse (EMP) attack, which involves the use of electromagnetic radiation to damage electronic devices and power sources. The idea of bombing data centers and cutting power grids have also been discussed as technically possible, but at present a practical and political paradox. For one, coordinated destruction of data centers would require simultaneous strikes across dozens of countries, any one of which could refuse and gain massive strategic advantage. "Blowing up data centers is great sci-fi. But in the real world, the most dangerous AIs won't be in one place — they'll be everywhere and nowhere, stitched into the fabric of business, politics, and social systems. That's the tipping point we should really be talking about," said Igor Trunov, founder of AI start-up Atlantix. The humanitarian crisis that would underlie an emergency attempt to stop AI could be immense. "A continental EMP blast would indeed stop AI systems, along with every hospital ventilator, water treatment plant, and refrigerated medicine supply in its range," Nag said. "Even if we could somehow coordinate globally to shut down all power grids tomorrow, we'd face immediate humanitarian catastrophe: no food refrigeration, no medical equipment, no communication systems." Distributed systems with redundancy weren't just built to resist natural failures; they inherently resist intentional shutdowns too. Every backup system, every redundancy built for reliability, can become a vector for persistence from a superintelligent AI that is deeply dependent on the same infrastructure that we survive on. Modern AI runs across thousands of servers spanning continents, with automatic failover systems that treat any shutdown attempt as damage to route around. "The internet was originally designed to survive nuclear war; that same architecture now means a superintelligent system could persist unless we're willing to destroy civilization's infrastructure," Nag said, adding, "Any measure extreme enough to guarantee AI shutdown would cause more immediate, visible human suffering than what we're trying to prevent." Anthropic researchers are cautiously optimistic that the work they are doing today — eliciting blackmail in Claude in scenarios specifically designed to do so — will help them prevent an AI takeover tomorrow. "It is hard to anticipate we would get to a place like that, but critical to do stress testing along what we are pursuing, to see how they perform and use that as a sort of guardrail," said Kevin Troy, a researcher with Anthropic. Anthropic researcher Benjamin Wright says the goal is to avoid the point where agents have control without human oversight. "If you get to that point, humans have already lost control, and we should try not to get to that position," he said. Trunov says that controlling AI is a governance question more than a physical effort. "We need kill switches not for the AI itself, but for the business processes, networks, and systems that amplify its reach," Trunov said, which he added means isolating AI agents from direct control over critical infrastructure. Today, no AI model — including Claude or OpenAI's GPT — has agency, intent, or the capability to self-preserve in the way living beings do. "What looks like 'sabotage' is usually a complex set of behaviors emerging from badly aligned incentives, unclear instructions, or overgeneralized models. It's not HAL 9000," Trunov said, a reference to the computer system in "2001," Stanley Kubrick's classic sci-fi film. "It's more like an overconfident intern with no context and access to nuclear launch codes," he added. Hinton eyes the future he helped create warily. He says if he hadn't stumbled upon the building blocks of AI, someone else would have. And despite all the attempts he and other prognosticators have made to game out what might happen with AI, there's no way to know for certain. "Nobody has a clue. We have never had to deal with things more intelligent than us," Hinton said. When asked whether he was worried about the AI-infused future that today's elementary school children may someday face, he replied: "My children are 34 and 36, and I worry about their future."
