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Marginalized Neighborhoods and Health Outcomes in Younger Myocardial Infarction Survivors
Leo E Akioyamen1, Atul Sivaswamy2, Olivia Haldenby2
1Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
JAMA Network Open
|July 2, 2025
Summary
Living in marginalized neighborhoods increases mortality risk for younger acute myocardial infarction (AMI) survivors. This study highlights disparities in care and outcomes, emphasizing the need for further investigation into systemic factors affecting patient health.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Health Services Research
Background:
- Neighborhood characteristics are increasingly recognized as significant determinants of health outcomes.
- Previous research suggests a link between socioeconomic factors and survival post-acute myocardial infarction (AMI).
- Understanding these associations is crucial for developing targeted interventions.
Purpose of the Study:
- To investigate the association between neighborhood marginalization and mortality in younger AMI survivors (<65 years).
- To examine disparities in healthcare utilization among these patients within a universal healthcare system.
- To identify potential structural and systemic factors contributing to adverse outcomes.
Main Methods:
- A population-based retrospective cohort study was conducted using clinical and administrative databases in Ontario, Canada.
- The study included younger patients hospitalized for their first AMI who survived to discharge between 2010 and 2019.
- Neighborhood marginalization was assessed using a composite metric, and proportional hazards regression models were used to analyze outcomes over 3 years.
Main Results:
- Increasing neighborhood marginalization was significantly associated with higher all-cause mortality rates in younger AMI survivors.
- At 3 years post-discharge, mortality rates ranged from 2.2% in the least marginalized to 5.2% in the most marginalized quintiles.
- Patients in more marginalized neighborhoods showed reduced utilization of primary care and cardiology services, as well as diagnostic testing.
Conclusions:
- Living in a marginalized neighborhood is linked to adverse outcomes, including increased mortality, for younger AMI survivors.
- Significant differences in healthcare service utilization were observed, suggesting potential systemic barriers.
- Further research is needed to elucidate the underlying structural and systemic factors driving these disparities.
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