• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (16)  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in this journal  Topic Collections  • Medical Practice  • Caring for the Uninsured and Underinsured  • Medical Practice, Other  • Cardiovascular System  • Prognosis/ Outcomes  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic  Social Bookmarking   What's this?

The Atherosclerosis Risk in Communities Study

Randi E. Foraker, MA; Kathryn M. Rose, PhD; Aileen P. McGinn, PhD; Chirayath M. Suchindran, PhD; David C. Goff Jr, MD, PhD; Eric A. Whitsel, MD, MPH; Joy L. Wood, MS; Wayne D. Rosamond, PhD

Arch Intern Med. 2008;168(17):1874-1879.

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.

Author Affiliations: Departments of Epidemiology (Mss Foraker and Wood and Drs Rose, Whitsel, and Rosamond), Biostatistics (Dr Suchindran), and Medicine (Dr Whitsel), University of North Carolina, Chapel Hill; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York (Dr McGinn); and Division of Public Health Sciences, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina (Dr Goff).

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

RELATED LETTER

Prehospital Delays in Patients Presenting With Myocardial Infarction
Madhavi Bollu, Andres C. Marte-Grau, and Ravi K. Bobba
Arch Intern Med. 2009;169(6):633.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Heart Disease and Stroke Statistics--2012 Update: A Report From the American Heart Association
Writing Group Members et al.
Circulation 2012;125:e2-e220.
FULL TEXT  

Socioeconomic status and incidence of sudden cardiac arrest
Reinier et al.
CMAJ 2011;183:1705-1712.
ABSTRACT | FULL TEXT  

Socioeconomic Status, Medicaid Coverage, Clinical Comorbidity, and Rehospitalization or Death After an Incident Heart Failure Hospitalization: Atherosclerosis Risk in Communities Cohort (1987 to 2004)
Foraker et al.
Circ Heart Fail 2011;4:308-316.
ABSTRACT | FULL TEXT  

Heart Disease and Stroke Statistics--2011 Update: A Report From the American Heart Association
Roger et al.
Circulation 2011;123:e18-e209.
FULL TEXT  

Delay From Symptom Onset to Hospital Presentation for Patients With Non-ST-Segment Elevation Myocardial Infarction
Ting et al.
Arch Intern Med 2010;170:1834-1841.
ABSTRACT | FULL TEXT  

Part 10: Acute Coronary Syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
O'Connor et al.
Circulation 2010;122:S787-S817.
FULL TEXT  

Part 9: Acute Coronary Syndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations
O'Connor et al.
Circulation 2010;122:S422-S465.
FULL TEXT  

Health Care Insurance, Financial Concerns in Accessing Care, and Delays to Hospital Presentation in Acute Myocardial Infarction
Smolderen et al.
JAMA 2010;303:1392-1400.
ABSTRACT | FULL TEXT  

Heart Disease and Stroke Statistics--2010 Update: A Report From the American Heart Association
WRITING GROUP MEMBERS et al.
Circulation 2010;121:e46-e215.
FULL TEXT  

Prehospital Delays in Patients Presenting With Myocardial Infarction
Bollu et al.
Arch Intern Med 2009;169:633-633.
FULL TEXT