The study found that heart attack patients with lower incomes have a higher risk of dying sooner than those with higher incomes.
Research from Harvard Medical School, the University of Texas Medical Branch at Galveston, ICES (formerly the Institute for Clinical Evaluative Sciences), and other international partners has revealed that mortality rates among low-income patients are 10–20% higher than those among high-income patients in six distinct countries.
According to the researchers, the results indicate that income-based disparities exist even in nations with universal healthcare and strong social services.
The International Health System Research Collaborative, an initiative devoted to understanding the trade-offs inherent in various nations’ approaches to delivering healthcare, produced the paper, which was published in the journal JAMA.
“A country’s health care system can impact treatment and outcomes for specific health conditions, like cardiovascular disease,” said Bruce Landon, professor of health care policy at the Blavatnik Institute at HMS.
“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,” he said.
In order to study all adults 66 years of age or older who were hospitalized with either non-ST-elevation myocardial infarction (NSTEMI) or ST-elevation myocardial infarction (STEMI), which is typically less severe, the authors analyzed population-based health care billing and claim data.
Between 2013 and 2018, outcomes for STEMI and NSTEMI patients in the United States, Canada (Ontario and Manitoba), England, the Netherlands, Taiwan, and Israel were compared with outcomes for patients with high incomes. The study included 843,046 patients with NSTEMI and 289,376 patients with STEMI who were hospitalized.
Findings showed that:
- Thirty-day mortality following hospitalization generally was 1 to 3 percentage points lower for high-income patients. The largest difference was seen in Canada (14.9 percent and 17.8 percent for high versus low-income individuals with STEMI).
- Differences in one-year mortality were even larger, with the highest difference in Israel (16.2 percent and 25.3 percent for high versus low-income individuals with STEMI).
- Low-income patients in all countries were less likely to receive necessary and aggressive treatments for STEMI, such as cardiac catheterisation and revascularization, and readmission rates to hospitals were higher than for low-income patients.
- There were more females in the lowest-income group compared to the highest-income group in all countries.
