Neighborhood Marginalization Worsens Outcomes in Young Myocardial Infarction Survivors

For many measures of socioeconomic, mental, and physical health, the neighborhoods we live in play an integral role. Cardiovascular health is no different, with neighborhood socioeconomic aspects—including the available resources to maintain healthy living or even the physical environment of the community itself—being critical predictors of long-term cardiovascular risk.^1,2

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Previous authors have affirmed that living in a disadvantaged neighborhood is related to a heightened incidence of coronary heart disease, even after controlling for personal socioeconomic indicators. These factors can be as rudimentary as discreet tobacco advertising or the cost and availability of healthy foods.^1,2

Beyond coronary heart disease, myocardial infarction, or heart attack, marginalization represents an especially concerning area of cardiovascular risk that is becoming more prevalent in younger adults, especially in the form of increased hospitalizations. Therefore, it is imperative to continue research into neighborhood marginalization in the area of myocardial infarction, specifically in a younger population. Any differences in neighborhoods that may heighten adverse cardiovascular outcomes, if identified, could be amended through policy interventions, improving outcomes across communities.^1,3

Investigators Seek to Assess Marginalization in Infarction Survivors

Investigators recently published new data in the Journal of the American Medical Association that helps fill such gaps in research regarding neighborhood marginalization and its contribution to myocardial infarction outcomes in younger adults. The results stem from a retrospective cohort study that utilized population-wide data from a universal health care system in Ontario and clinical data from the CorHealth Ontario Cardiac Registry to assess outcomes of younger patients who survived acute myocardial infarction (AMI).¹

Primarily, the authors examined all-cause death, with additional outcomes including adverse outcomes following the index hospitalization and visits to primary care physicians and cardiologists, diagnostic tests, and invasive treatments. Outcomes were examined within 30 days, 1 year, and 3 years. Following extensive consideration and analysis, the investigators included 65,464 patients in the sample; the median age was 56 years, with patients in marginalized quintiles of the sample being more likely to have preexisting cardiac risk factors.¹

Marginalization Increases Mortality, Reduces Health Care Provider Visits

Mortality and adverse outcomes following index AMI hospitalization occurred on a gradient of increasing risk in accordance with increasing neighborhood marginalization, a trend that began at 30 days post-discharge and was sustained—or worsened—over time, according to the investigators. Following confounder adjustment, patients in the most marginalized neighborhood quintile had substantially greater hazards of all-cause death over 30 days (hazard ratio [HR] = 2.43 [95% CI, 1.41–4.18]) and hospitalization from all causes (HR = 1.16 [95% CI, 1.05–1.28]).¹

The gradients of increasing adverse outcomes with heightened marginalization persisted 1 year following the index AMI, with patients from the highest quintile of marginalization demonstrating the highest adjusted hazard ratios (AHR) of all-cause death (AHR = 1.80 [95% CI, 1.39–2.23]) and hospitalization from all causes (AHR = 1.20 [95% CI, 1.13–1.28]). Accordingly, 3 years following the index hospitalization, these outcome gradients were largely sustained.¹

Regarding care processes following index AMI hospitalization, the investigators observed gradients in the proportion of those with at least 1 physician visit or cardiac diagnostic test by neighborhood marginalization. There were particularly low rates of 30-day follow-up with primary care physicians and cardiologists in the most marginalized quintile; these patients were also less likely to receive an echocardiogram.¹

The differences observed among younger AMI survivors in this study were indeed stark, highlighting the distinct need to focus on younger adults in marginalized communities for cardiovascular risk reduction. Pharmacists, as trusted health care professionals who frequently encounter patients, can play a critical role, especially if they work in marginalized communities. Through acts as simple as reminding patients about routine physicals or cardiologist visits if they are at increased risk or recommending lifestyle changes, pharmacists can help patients in these communities overcome their health care gaps.¹

Ultimately, though, these results suggest that the barriers to care stemming from AMI hospitalization persist following the index event and can go beyond financial obstacles. Thorough counseling of young adults following a myocardial infarction event should be employed by pharmacists, especially since these patients are more likely to not visit their physician or cardiologist following the event.¹

“Our findings suggest that younger individuals may be more vulnerable to the adverse effects of neighborhood marginalization and that universal health care may be insufficient to redress outcome inequities after AMI,” the study authors concluded.¹

REFERENCES

1. Akioyamen LE, Sivaswamy A, Haldenby O, et al. Marginalized Neighborhoods and Health Outcomes in Younger Myocardial Infarction Survivors. JAMA Netw Open. 2025;8(7):e2518826. doi:10.1001/jamanetworkopen.2025.18826

2. Diez Roux AV, Merkin SS, Arnett D, et al. Neighborhood of Residence and Incidence of Coronary Heart Disease. N Engl J Med. 2001;345(2):99-106. doi:10.1056/NEJM200107123450205

3. Gupta A, Wang Y, Spertus JA, et al. Trends in Acute Myocardial Infarction in Young Patients and Differences by Sex and Race, 2001 to 2010. JACC Journals. 2014;64(4):337-345. doi:.org/10.1016/j.jacc.2014.04.054