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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).

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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.
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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

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