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Heart-attack survival, female income linked

Income seems to make a huge difference in heart attack survival in women diagnosed with heart disease.

That's the result of a study conducted at LDS Hospital that is being presented Friday at a national epidemiology meeting of the American Heart Association in Miami.

The LDS Hospital study of more than 7,100 heart disease patients found that women living in residential areas where the median household income was less than $32,000 had a 30 percent higher rate of death or heart attack in the years following diagnosis than did men in the same areas.

"The idea that socioeconomics relates to cardiovascular outcomes is not a new one," said Dr. Joseph Brent Muhlestein, director of cardiology research at LDS Hospital. But the researchers wondered if that would be true in Utah, as well, where there are "more homogenous lifestyles."

It was.

The study included patients treated at LDS Hospital for advanced coronary artery disease between 1993 and 1999, said hospital spokesman Jess Gomez. The researchers looked at patient progress retrospectively for up to seven years using the hospital's computer database, then compared outcomes by gender and residential economic status, determined by the median household income of each person's home ZIP code.

Outcomes for people in low-income areas were worse than for their more well-to-do counterparts across the board — an almost 50 percent difference between women in areas where the median household income level was below the $32,000 threshold and those where the income was above that. But the difference between the low-income women's outcomes and the men's was so profound it reduced the statistical significance of the difference between low-income men and wealthier men. The women accounted for most of the difference between income levels overall.

Why women in lower-income areas have such bleak prospects is not known and would require a lot more study, Muhlestein said, but there are some theories. For one thing, "we know there's a reduction in mortality for people who get on all four of the medications that prevent heart attack," he said. "We think there's a correlation between income and whether they stay on the medications."

That may be hard to do for widows living on a fixed income, he said. And the women may be more apt to forego medication and other care to pay other bills.

Some of Muhlestein's colleagues theorize that there's a tendency for a woman to take responsibility for the entire family, even after children are grown. That could lead her to prioritize her own health-care needs last behind other expenses.

Muhlestein hopes to do more study on the issue, using confidential questionnaires to determine actual income of some of the people in the study, rather than just Census tract income figures.

Besides benefiting individual patients, it could reduce overall health-care costs. "So much of medical care is leaving the hospital and going to long-term therapy now," he said. "It makes no sense to pay for a bypass and then not be able to have the medications to prevent a second heart attack."

The study found that the incidence of death or subsequent heart attack for women in higher-income areas was slightly higher than for men in comparable areas.

Increasingly, LDS Hospital and others are looking specifically at women's health issues, an area that was traditionally overlooked.

Members of the LDS Hospital research team include Muhlestein, Sandra P. Reyna, Benjamin D. Horne, Tami L. Bair, Chloe Allen Maycock, Robert R. Pearson, Stephanie V. Moore, Dale G. Renlund and Jeffrey L. Anderson.