Poorer people worse off after heart attack

October 26, 1999

(Toronto, ON) - Despite universal health coverage, heart attack patients who live in poorer neighbourhoods are dying at a higher rate and experience greater barriers to specialist services than more wealthy Ontarians.

This finding is from a report published by researchers at the Institute for Clinical Evaluative Sciences (ICES) and the University of Toronto today in the New England Journal of Medicine. The purpose of the study was to test medicare's underlying principles of universal access and equity by measuring the outcomes of heart attack patients from different socioeconomic backgrounds.

"We are still uncertain what is driving these differences," says coauthor Dr. David Alter, a cardiologist and researcher at ICES. "But what is certain is that these differences exist and we must ensure that health care delivery and health promotion is targeted to all segments of society."

The study used the average income of the community in which the patients lived as an indicator of their socioeconomic status. Income had a direct relationship on the risk of death within one year of the heart attack and on access to certain cardiovascular services (e.g. angiography, angioplasty, bypass surgery). For every $10,000 increase in average neighbourhood income there was an associated 10 per cent reduction in the risk of death.

Dr. David Naylor, coauthor of the study and dean of the University of Toronto's faculty of medicine adds, "We need to untangle the various patient, system and societal factors that have an impact on survival after a heart attack. Patient characteristics such as traditional risk factors, compliance with medication and psychosocial stresses, as well as treatment differences after the heart attack, play an important part in survival."

Patients in poorer neighbourhoods also face inequities in access to revascularization services. While differential use of revascularization services is unlikely to account for the observed mortality differences, these services do have a direct impact on patients' quality of life. "Ontario has to ensure that its poorer citizens are not further disadvantaged as a result of ignoring the importance of socioeconomic status in cardiovascular health," adds Alter, who conducted this research as part of his PhD thesis at the University of Toronto.

The study tracked 51,591 heart attack patients between April 1994 and March 1997 and was funded, in part, by the Medical Research Council of Canada.

ICES is a non-profit health services research organization dedicated to improving the effectiveness, quality, equity, accessibility and efficiency of health care in Ontario.
Steven de Sousa
Public Affairs, University of Toronto
email: steven.desousa@utoronto.ca

University of Toronto

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