{"id":13261,"date":"2023-04-04T00:00:00","date_gmt":"2023-04-04T04:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/news-releases\/low-income-patients-at-higher-risk-of-death-after-heart-attack-regardless-of-what-country-they-live-in\/"},"modified":"2023-06-14T18:18:16","modified_gmt":"2023-06-14T22:18:16","slug":"low-income-patients-at-higher-risk-of-death-after-heart-attack-regardless-of-what-country-they-live-in","status":"publish","type":"news_release","link":"https:\/\/www.ices.on.ca\/fr\/news-releases\/low-income-patients-at-higher-risk-of-death-after-heart-attack-regardless-of-what-country-they-live-in\/","title":{"rendered":"Low-income patients at higher risk of death after heart attack, regardless of what country they live in"},"content":{"rendered":"<p>Despite vastly different healthcare systems, low-income patients across six different countries have mortality rates that are 10 to 20% greater than their high-income peers, according to a new study from <strong>ICES<\/strong>, Harvard Medical School, and the University of Texas Medical Branch, Galveston.<\/p>\n<p>\nThe researchers say that the findings suggest there are income-based disparities present even in countries with universal healthcare and robust social services.<\/p>\n<div>\n<div class=\"download-section alignwide infographic-download\" id=\"block_bf78dbed09de537e877c4741b9fd4e91\" data-style=\"deep-blue\">\n\t<div class=\"download-section-content\">\n\t\t\t\t<h2>\n\t\t\tInfographic\t\t<\/h2>\n\t\t\n\t\t\t<\/div>\n\t<div class=\"download-section-buttons\">\n\t\t\t\t\t\t<a class=\"download-section-buttons-primary\" href=\"https:\/\/www.ices.on.ca\/wp-content\/uploads\/2023\/05\/Landon-Heart-Attack.png\" target=\"_blank\"\n\t\t\tdownload\t\t\taria-label=\"Download Infographic (opens in a new tab)\"\t\t>\n\t\t\tDownload Infographic\t\t\t<svg width=\"19\" height=\"19\" viewBox=\"0 0 19 19\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" role=\"presentation\">\n<path d=\"M2.78003 18.8301C2.14282 18.8301 1.59713 18.603 1.14297 18.1488C0.688813 17.6947 0.46212 17.1494 0.462893 16.5129V13.0372H2.78003V16.5129H16.6829V13.0372H19V16.5129C19 17.1502 18.7729 17.6958 18.3188 18.15C17.8646 18.6042 17.3193 18.8308 16.6829 18.8301H2.78003ZM9.73145 14.1958L3.9386 8.40295L5.5606 6.72303L8.57288 9.73531V0.292969H10.89V9.73531L13.9023 6.72303L15.5243 8.40295L9.73145 14.1958Z\" fill=\"#151D5D\"\/>\n<\/svg>\n\t\t<\/a>\n\t\t\n\t\t\t\t\t\t\t\t\t\t<button type=\"button\" class=\"download-section-buttons-secondary\" data-infographic-popup-open=\"block_bf78dbed09de537e877c4741b9fd4e91-infographic-popup\" aria-haspopup=\"dialog\">\n\t\t\t\tClick to View\t\t\t<\/button>\n\t\t\t\t\t\t<\/div>\n\n\t\t<div class=\"infographic-popup\" id=\"block_bf78dbed09de537e877c4741b9fd4e91-infographic-popup\" role=\"dialog\" aria-modal=\"true\" aria-label=\"Infographic\" hidden>\n\t\t<div class=\"infographic-popup-overlay\" data-infographic-popup-close><\/div>\n\t\t<div class=\"infographic-popup-container\">\n\t\t\t<button type=\"button\" class=\"infographic-popup-close\" data-infographic-popup-close aria-label=\"Close infographic\">&times;<\/button>\n\t\t\t<img decoding=\"async\" class=\"infographic-popup-image\" src=\"https:\/\/www.ices.on.ca\/wp-content\/uploads\/2023\/05\/Landon-Heart-Attack.png\" alt=\"Infographic\">\n\t\t<\/div>\n\t<\/div>\n\t<\/div>\n<\/div>\n<p>\n&#x201c;A country&#x2019;s healthcare system can impact treatment and outcomes for specific health conditions, like cardiovascular disease,&#x201d; says Bruce Landon, an internist and professor of medicine at the Beth Israel Deaconess Medical Center, and professor of healthcare policy at Harvard Medical School. &#x201c;We wanted to explore whether the poorer outcomes that have been observed in lower-income Americans relative to higher-income Americans were reduced in countries with universal health insurance. We found that high-income individuals had better survival rates and were more likely to receive life-saving treatments compared to low-income individuals, regardless of their country of residence or type of health system.&#x201d;<\/p>\n<p>\nThe authors analyzed medical records of all adults 66 years or older who were hospitalized with a type of heart attack known as ST-elevation myocardial infarction (STEMI, which tends to be more severe) and non-ST-elevation myocardial infarction (NSTEMI). Outcomes for STEMI and NSTEMI patients with low incomes were compared with outcomes among patients with high income in the US, Canada (Ontario and Manitoba), England, Netherlands, Taiwan, and Israel between 2013 and 2018.<\/p>\n<p>\nPublished in the journal <em>JAMA<\/em>, the study included 289,376 patients hospitalized with STEMI and 843,046 patients hospitalized with NSTEMI. Findings showed that:<\/p>\n<ul class=\"list-style\">\n<li>Thirty-day mortality following hospitalization generally was 1-3 percentage points lower for high-income patients. The largest difference was seen in Canada (14.9% and 17.8% for high versus low-income individuals with STEMI).<\/li>\n<li>Differences in one-year mortality were even larger, with the highest difference in Israel (16.2% and 25.3% for high versus low-income individuals with STEMI).<\/li>\n<li>Low-income patients in all countries were less likely to receive necessary and aggressive treatments for STEMI, including cardiac catheterization and revascularization, and readmission rates to hospital were higher than for low-income patients.<\/li>\n<li>There were more females in the lowest-income group compared to the highest-income group in all countries.<\/li>\n<\/ul>\n<p>\n&#x201c;These results suggest that countries around the world need to redouble their efforts to assure the delivery of equitable care to persons across the spectrum of socioeconomic status,&#x201d; says Dr. Landon.\n<\/p>\n<p>\nThough the researchers accounted for the possible effects of other diseases the patients had, it is still possible that there were other health-related factors that influenced higher rates of death and lower rates of treatment for low-income patients. The authors caution they did not adjust for race and ethnicity because these data were not available for all the countries and populations included in the study. Moreover, all Americans in the study had health insurance, so it is unclear if the results might have been different if uninsured Americans were included.<\/p>\n<p>\nThe researchers say that further efforts are needed to explore the availability and quality of hospital care in these regions, which could affect a patient&#x2019;s access to treatment.<\/p>\n<p>\n&#x201c;Our results challenge the belief that income-based disparities are a uniquely American phenomenon. The truth is that the poverty penalty seems consistent across countries,&#x201d; says senior author <a href=\"\/ices-scientists\/peter-cram\/\">Peter Cram<\/a>, an adjunct scientist at ICES and The University of Texas Medical Branch, Galveston. &#x201c;All countries, including Canada, need to address these issues and improve healthcare delivery for older patients who experience severe heart attacks.&#x201d;<\/p>\n<p>\nThe study &#x201c;Differences in treatment patterns and outcomes of acute myocardial infarction for low- and high-income patients in 6 countries: an analysis from the International Health Systems Research Collaborative&#x201d; was published in <em>JAMA<\/em>.<\/p>\n<p><em><br \/>\nAuthor block: Landon BE, Hatfield LA, Bakx P, Banerjee A, Chen Y-C, Fu C, Gordon M, Heine R, Huang N, Ko DT, Lix LM, Novack V, Pasea L, Qiu F, Stukel TA, Uyl-de Groot C, Yan L, Weinreb G, Cram P.<\/em><\/p>\n<div><div class=\"about-ices-shortcode\"><p><strong>ICES<\/strong> is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: <a href=\"https:\/\/twitter.com\/ICESOntario\" target=\"_blank\" rel=\"noopener\">@ICESOntario<\/a><\/p>\n<\/div><\/div>\n<h2>\nFOR FURTHER INFORMATION PLEASE CONTACT:<\/h2>\n<p>\nMisty Pratt<br \/>\nSenior Communications Officer, ICES<br \/>\n<a href=\"mailto:Misty.Pratt@ices.on.ca\">Misty.Pratt@ices.on.ca<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Despite vastly different healthcare systems, low-income patients across six different countries have mortality rates that are 10 to 20% greater than their high-income peers, according to a new study from ICES, Harvard Medical School, and the University of Texas Medical Branch, Galveston. The researchers say that the findings suggest there are income-based disparities present even [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[],"class_list":["post-13261","news_release","type-news_release","status-publish","hentry"],"acf":{"infographic":[13304],"journal_article":[13243],"research_report":[],"atlas":[],"research_program":[6746],"site":[6733],"ices_scientist":[1187],"announce_or_event":[],"video":[],"iitn_type":false,"iitn_title":"People from low-income areas more likely to die after a heart attack, major study says","iitn_short_title":"","iitn_source_link_url":"https:\/\/www.thestar.com\/news\/canada\/2023\/04\/04\/people-from-low-income-areas-more-likely-to-die-after-a-heart-attack-major-study-says.html","iitn_source_link_text":"Toronto Star","sitecore_item_id":"65FB6284-FA83-41C5-B919-B0825F10C961","sitecore_item_name":"Low-income-patients-at-higher-risk-of-death-after-heart-attack","sitecore_field_values":"{\n  \"Content\": \"<p>Despite vastly different healthcare systems, low-income patients across six different countries have mortality rates that are 10 to 20% greater than their high-income peers, according to a new study from <strong>ICES<\/strong>, Harvard Medical School, and the University of Texas Medical Branch, Galveston.<\/p>n<p>nThe researchers say that the findings suggest there are income-based disparities present even in countries with universal healthcare and robust social services.<\/p>n<p><a href=\"~\/media\/8749F7482E7A4DEE974951BF72CF8D3F.ashx\" onclick=\"_gaq.push(['_trackEvent','Download', 'Landon-Heart-Attack-Infographic-April2023', this.href]);\"><img height=\"437\" alt=\"Low-income patients at higher risk of death after heart attack, regardless of country they live in\" width=\"350\" src=\"~\/media\/9F5CD02960B24F8584740AE97882EC4A.ashx\" \/><\/a><span class=\"grey\" style=\"font-size: 12px; font-weight: bold; display: block; color: #5b5656;\">Click image to enlarge<\/span><\/p>n<p>n&ldquo;A country&rsquo;s healthcare system can impact treatment and outcomes for specific health conditions, like cardiovascular disease,&rdquo; says Bruce Landon, an internist and professor of medicine at the Beth Israel Deaconess Medical Center, and professor of healthcare policy at Harvard Medical School. &ldquo;We wanted to explore whether the poorer outcomes that have been observed in lower-income Americans relative to higher-income Americans were reduced in countries with universal health insurance. We found that high-income individuals had better survival rates and were more likely to receive life-saving treatments compared to low-income individuals, regardless of their country of residence or type of health system.&rdquo;<\/p>n<p>nThe authors analyzed medical records of all adults 66 years or older who were hospitalized with a type of heart attack known as ST-elevation myocardial infarction (STEMI, which tends to be more severe) and non-ST-elevation myocardial infarction (NSTEMI). Outcomes for STEMI and NSTEMI patients with low incomes were compared with outcomes among patients with high income in the US, Canada (Ontario and Manitoba), England, Netherlands, Taiwan, and Israel between 2013 and 2018.<\/p>n<p>nPublished in the journal <em>JAMA<\/em>, the study included 289,376 patients hospitalized with STEMI and 843,046 patients hospitalized with NSTEMI. Findings showed that:<\/p>n<ul class=\"list-style\">n    <li>Thirty-day mortality following hospitalization generally was 1-3 percentage points lower for high-income patients. The largest difference was seen in Canada (14.9% and 17.8% for high versus low-income individuals with STEMI).<\/li>n    <li>Differences in one-year mortality were even larger, with the highest difference in Israel (16.2% and 25.3% for high versus low-income individuals with STEMI).<\/li>n    <li>Low-income patients in all countries were less likely to receive necessary and aggressive treatments for STEMI, including cardiac catheterization and revascularization, and readmission rates to hospital were higher than for low-income patients.<\/li>n    <li>There were more females in the lowest-income group compared to the highest-income group in all countries.<\/li>n<\/ul>n<p>n&ldquo;These results suggest that countries around the world need to redouble their efforts to assure the delivery of equitable care to persons across the spectrum of socioeconomic status,&rdquo; says Dr. Landon.n<\/p>n<p>nThough the researchers accounted for the possible effects of other diseases the patients had, it is still possible that there were other health-related factors that influenced higher rates of death and lower rates of treatment for low-income patients. The authors caution they did not adjust for race and ethnicity because these data were not available for all the countries and populations included in the study. Moreover, all Americans in the study had health insurance, so it is unclear if the results might have been different if uninsured Americans were included.<\/p>n<p>nThe researchers say that further efforts are needed to explore the availability and quality of hospital care in these regions, which could affect a patient&rsquo;s access to treatment.<\/p>n<p>n&ldquo;Our results challenge the belief that income-based disparities are a uniquely American phenomenon. The truth is that the poverty penalty seems consistent across countries,&rdquo; says senior author <a href=\"~\/link.aspx?_id=4DDEBA666CEA43A883C36D1BDA5E9573&amp;_z=z\">Peter Cram<\/a>, an adjunct scientist at ICES and The University of Texas Medical Branch, Galveston. &ldquo;All countries, including Canada, need to address these issues and improve healthcare delivery for older patients who experience severe heart attacks.&rdquo;<\/p>n<p>nThe study &ldquo;Differences in treatment patterns and outcomes of acute myocardial infarction for low- and high-income patients in 6 countries: an analysis from the International Health Systems Research Collaborative&rdquo; was published in <em>JAMA<\/em>.<\/p>n<p><em>nAuthor block: Landon BE, Hatfield LA, Bakx P, Banerjee A, Chen Y-C, Fu C, Gordon M, Heine R, Huang N, Ko DT, Lix LM, Novack V, Pasea L, Qiu F, Stukel TA, Uyl-de Groot C, Yan L, Weinreb G, Cram P.<\/em><\/p>n<p><em><span style=\"color: #002060;\"><strong>ICES<\/strong> is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter:<\/span> <a href=\"https:\/\/twitter.com\/ICESOntario\">@ICESOntario<\/a><\/em><\/p>n<h2>nFOR FURTHER INFORMATION PLEASE CONTACT:<\/h2>n<p>nMisty Pratt<br \/>nSenior Communications Officer, ICES<br \/>n<a href=\"mailto:Misty.Pratt@ices.on.ca\">Misty.Pratt@ices.on.ca<\/a><\/p>\",\n  \"Title\": \"Low-income patients at higher risk of death after heart attack, regardless of what country they live in\",\n  \"Short title\": \"Low-income patients at higher risk of\",\n  \"Teaser image\": \"<image mediaid=\"{A322F4BD-074D-4BD9-A21A-A9A358DE2CFF}\" alt=\"&quot;&quot;\" height=\"\" width=\"\" hspace=\"\" vspace=\"\" \/>\",\n  \"Summary\": \"Despite vastly different healthcare systems, low-income patients across six different countries have mortality rates that are 10 to 20% greater than their high-income peers.\",\n  \"Location\": \"Toronto\",\n  \"In The News\": \"{72E1CA6A-0B6F-4F65-AD4D-031944D0B4A5}|{B9FBEADC-D573-49B1-BB77-1BD8079DAB01}\",\n  \"ICES Scientists\": \"{4DDEBA66-6CEA-43A8-83C3-6D1BDA5E9573}\",\n  \"ICES Locations\": \"{4FCAABBA-14A5-42E6-8F33-BC6C2F1D9908}\",\n  \"Research Programs\": \"{CFE36C89-C969-4C23-B5E4-1BA9E5BDC273}\",\n  \"Posted Date\": \"20230404T000000\",\n  \"Publication Link\": \"<link text=\"Abstract\" linktype=\"internal\" title=\"opens related abstract\" querystring=\"\" target=\"\" id=\"{C8987D57-9A4A-4D00-AF3F-E504D9D01976}\" \/>\",\n  \"Related Link\": \"<link text=\"Infographic\" linktype=\"external\" url=\"~\/Publications\/Infographics?year=2023&amp;page=1#Landon-Heart-Attack\" anchor=\"\" title=\"opens related infographic\" target=\"\" \/>\",\n  \"Related Link2\": \"<link text=\"ICES in the News | Globe &amp; Mail\" linktype=\"external\" url=\"https:\/\/www.theglobeandmail.com\/canada\/article-heart-attack-patients-neighbourhoods-study\/\" anchor=\"\" title=\"opens external link\" target=\"\" \/>\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Newsroom\/News-Releases\/2023\/Low-income-patients-at-higher-risk-of-death-after-heart-attack"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Low-income patients at higher risk of death after heart attack, regardless of what country they live in<\/title>\n<meta name=\"description\" content=\"Despite vastly different healthcare systems, low-income patients across six different countries have mortality rates that are 10 to 20% greater than their\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ices.on.ca\/fr\/news-releases\/low-income-patients-at-higher-risk-of-death-after-heart-attack-regardless-of-what-country-they-live-in\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" 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