Neighborhood Socioeconomic Status Predicts Health After Hospitalization for Acute Coronary Syndromes

Findings From TRACE-Core (Transitions, Risks, and Actions in Coronary Events—Center for Outcomes Research and Education)

Bibliographic Data

ID9101743
AuthorsLisa Nobel (0000-0002-9625-3592, University of Massachusetts Chan Medical School, corresponding author), William M Jesdale (University of Massachusetts Chan Medical School, corresponding author), Jennifer Tjia (0000-0003-4541-0460, University of Massachusetts Chan Medical School, corresponding author), Molly E Waring (0000-0002-9884-9824, University of Massachusetts Chan Medical School, corresponding author), David C Parish (0000-0002-0971-0354, Mercer University), Arlene S Ash (0000-0002-8448-0253, University of Massachusetts Chan Medical School, corresponding author), Catarina I Kiefe (0000-0001-8719-6963, University of Massachusetts Chan Medical School, corresponding author), Jeroan J Allison (0000-0003-4472-2112, University of Massachusetts Chan Medical School, corresponding author)
Year2017
Volume55
Issue12
Pages1008-1016
Publication date2017-12-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000819
PMID29016395
OpenAlexW2763733378
LanguageEN
References cited42

OBJECTIVE: To explore the influence of contextual factors on health-related quality of life (HRQoL), which is sometimes used as an indicator of quality of care, we examined the association of neighborhood socioeconomic status (NSES) and trajectories of HRQoL after hospitalization for acute coronary syndromes (ACS). METHODS: We studied 1481 patients hospitalized with acute coronary syndromes in Massachusetts and Georgia querying HRQoL via the mental and physical components of the 36-item short-form health survey (SF-36) (MCS and PCS) and the physical limitations and angina-related HRQoL subscales of the Seattle Angina Questionnaire (SAQ) during hospitalization and at 1-, 3-, and 6-month postdischarge. We categorized participants by tertiles of the neighborhood deprivation index (a residence-census tract-based measure) to examine the association of NSES with trajectories of HRQoL after adjusting for individual socioeconomic status (SES) and clinical characteristics. RESULTS: Participants had mean age 61.3 (SD, 11.4) years; 33% were female; 76%, non-Hispanic white; 11.2% had household income below the federal poverty level. During 6 months postdischarge, living in lower NSES neighborhoods was associated with lower mean PCS scores (1.5 points for intermediate NSES; 1.8 for low) and SAQ scores (2.4 and 4.2 points) versus living in high NSES neighborhoods. NSES was more consequential for patients with lower individual SES. Individuals living below the federal poverty level had lower average MCS and SAQ physical scores (3.7 and 7.7 points, respectively) than those above. CONCLUSIONS: Neighborhood deprivation was associated with worse health status. Using HRQoL to assess quality of care without accounting for individual SES and NSES may unfairly penalize safety-net hospitals

Environmental health · Population · Poverty · Quality of life (healthcare) · Residence · Socioeconomic status · Cardiac Health and Mental Health · Demography · Geriatric Care and Nursing Homes · Health disparities and outcomes · Medicine · Gerontology