Heart Attack Care Often Delayed for the Poor

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Their conclusions stem from an analysis of more than 6,700 medical records of men and women who experienced a heart attack between 1993 and 2002. By matching patient addresses to 2000 U.S. census data, the research team was able to establish household income levels as either low (less than $33,533), medium (between $33,533 and $50,031) or high (over $50,032).

Foraker and her colleagues determined that 36 percent of the patients faced a short delay (less than two hours) in reaching their local hospital. Another 42 percent experienced a medium delay of between two and 12 hours, while 22 percent underwent a long delay of between 12 hours and three days.

After accounting for such factors as age, gender, health insurance status, history of diabetes and/or high blood pressure, distance to hospital, and race, the study authors found that Medicaid patients and those living in low-income areas were relatively more likely to experience a long or medium delay in getting to the hospital for heart attack care.

For example, patients residing in lower-income neighborhoods were 46 percent more likely to experience a long rather than a short delay in getting to a hospital after heart attack, the study found. And patients on Medicaid were 87 percent more likely to wait a long time before having their symptoms seen to, the team reported.

Why the disparity based on income? The researchers aren't sure. They noted that one factor -- a lack of health insurance -- didn't seem to affect wait times.

"From a public health standpoint these disparities should be further investigated," said Foraker. "And in the meantime, to reduce these disparities, one of the targets may be to increase the recognition of symptoms of a heart attack. And to promote EMS use throughout the community, so people know to call an ambulance right away when they experience these symptoms."

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