Racial and socioeconomic aspects of myocardial infarction recovery: studying confounds

Cardiovascular disease rates illustrate the excess morbidity and mortality associated with race and social class. However, while prevalence and deaths from heart disease are greater among black and lower socioeconomic status (SES) populations, researchers rarely consider possible confounds between race and SES. In a longitudinal study of 246 older myocardial infarction (MI) patients, differences appeared in both morbid events and death for black and lower SES patients. Simultaneous comparison of race and SES showed significantly different outcomes among black low SES, black high SES, white low SES, and white high SES patients that confirmed the predicted ranking of these groups. Low SES black subjects ranked last in physical functioning and cardiac symptomatology, whereas high SES white subjects ranked first in preventive health opportunities. We also considered the potential race-SES confound as an interaction term in multiple regression analysis, and three recovery outcomes were significantly predicted by the joint effects of these variables. These findings demonstrate that failure to consider SES of black and white patients jointly, as well as individually, can lead to erroneous conclusions about health.