Neighborhood Socioeconomic Status Predicts Health After Hospitalization for Acute Coronary Syndromes

Abstract

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 1,481patients hospitalized with ACS in Massachusetts and Georgia querying HRQoL via the mental and physical components of the 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-months post-discharge. 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 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 post-discharge, 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. Neighborhood SES 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 and neighborhood SES may unfairly penalize safety net hospitals.

Understanding social inequality in ischemic heart disease from a psychosocial perspective: A qualitative study of the influence of psychosocial factors on socially disadvantaged patients' lived experience of life with ischemic heart disease

“…Research shows that ischemic heart patients with low socioeconomic status experience worse physical functioning, poorer mental health and health-related quality, and more comorbidity than patients with high socioeconomic status (Barbareschi et al, 2009;Matetic et al, 2020;Nobel et al, 2017). This inequality in the health and well-being of patients living with ischemic heart disease constitute a growing public health problem, which may be related to the rising prevalence of people living with ischemic heart disease since the 1970s (Havranek et al, 2015).…”

“…Studies of social inequalities in life with ischemic heart disease tend to use quantitative study design and be based on patient-reported outcomes (PROMs) collected by use of standardized measurement tools (Badarienė et al, 2020;Nobel et al, 2017;Schultz et al, 2018;Shahu et al, 2020). Several generic assessment tools exist enabling exploration of the patient's perceived quality of life, symptoms and functional status, feelings and attitude about illness as well as their experience of healthcare (Forestier et al, 2019).…”

“…Existing research has shown that social inequality in health and well-being of those living with ischemic heart disease is a growing international public health concern ( Barbareschi et al, 2009;Matetic et al, 2020;Nobel et al, 2017). When trying to understand and reduce these inequalities, research and policy often emphasize patients' individual actions and capabilities (De Bacquer et al, 2021;Hald et al, 2019;Hicks et al, 2020;Hutchison & Holdsworth, 2019;Kulhánová et al, 2016;Notara et al, 2014;Schultz et al, 2018).…”

“…Furthermore, studies of social inequality in the experience of life with ischemic heart disease often deploy quantitative study designs and standardized measurement tools (Badarienė et al, 2020;Nobel et al, 2017;Schultz et al, 2018;Shahu et al, 2020). These study designs may provide an overview of the magnitude of the problem and demonstrate causal relationships.…”