Blacks in all socioeconomic groups have poorer outcomes after heart attack

Black patients and patients with low socioeconomic status have shorter life expectancies after a heart attack. However, the largest racial differences in life expectancy after a heart attack occur in patients with high socioeconomic status, according to research in the American Heart Association journal Circulation.

"Race and socioeconomic status are intimately related, with black individuals bearing a disproportionate burden of the poverty and health inequalities in the U.S.," said Emily Bucholz, M.D., MPH, Ph.D., lead author of the study and resident at Boston Children's Hospital. "Prior research has shown that blacks fare worse after cardiac events, yet little is known about how these factors interact to affect outcomes after heart attack."

Researchers, evaluating Medicare data based on zip code information on 132,201 white patients and 8,894 black patients in the U.S. found on average: white patients lived longer than black patients after a heart attack and patients with high socioeconomic status lived longer than those with low socioeconomic status:

Overall, white patients lived an average of 6.4 years after heart attack whereas black patients lived an average of 5.6 years.

Racial differences in life expectancy were largest in patients with high socioeconomic status and lowest in patients with low socioeconomic status. Among those living in high socioeconomic communities, life expectancy was 7.0 years in white patients and 6.3 years in black patients.

Among those living in low socioeconomic areas, life expectancy was 5.6 in white patients and 5.4 in black patients.

Much of the racial difference in life expectancy was explained by the higher rate of cardiovascular disease risk factors (diabetes, hypertension, smoking) and lower treatment rates in black patients

"The implication here is that black patients and poor patients are disadvantaged—and higher socioeconomic status does not eliminate racial disparities," said Harlan Krumholz, M.D., M.S., study co-author and researcher at Yale University in New Haven, Connecticut. "We have work to do to understand why blacks are disadvantaged and immediately address it."

The study was based on data from the mid-1990s, but the findings still provide additional context on where to direct future heart health initiatives, said Bucholz.

"What was most surprising to us was that the greatest gap in life expectancy after a heart attack was between blacks and whites at the higher end of the socioeconomic status spectrum," Bucholz said. "We don't know why this is, but it indicates that blacks with greater resources remain vulnerable to poorer outcomes."