Younger Heart Attack Survivors in Marginalized Neighborhoods Face Higher Death Rates Despite Universal Health Care: Study
Canada: Researchers have found in a new study that younger individuals who survive acute myocardial infarction (AMI) and live in marginalized neighborhoods face higher long-term health risks, including increased mortality, repeat hospitalizations, and recurrent heart attacks—even within the context of a universal health care system.
The study, published in JAMA Network Open, was conducted by Dr. Leo E. Akioyamen and colleagues from the Department of Medicine at the University of Toronto. It analyzed over 65,000 younger patients across Ontario, Canada, who experienced their first heart attack between 2010 and 2019 and survived at least seven days after hospital discharge.
The researchers explored how neighborhood-level social disadvantages—such as material deprivation, residential instability, and dependency—impacted health outcomes over time.
The following were the key findings of the study:
- The study found a strong association between neighborhood marginalization and poorer health outcomes following hospital discharge for heart attack survivors.
- Within three years of discharge, mortality rates were more than double in patients from the most marginalized neighborhoods (5.2%) compared to those from the least marginalized areas (2.2%).
- Disparities in outcomes began as early as 30 days after discharge and continued over time, with higher rates of both mortality and hospital readmissions seen in more marginalized populations.
- Even after accounting for various clinical factors, the risk of death remained elevated in patients from marginalized communities, with adjusted hazard ratios ranging from 1.13 in the second quintile to 1.52 in the highest quintile of marginalization.
- The study also highlighted significant gaps in access to follow-up care, with those in the most marginalized neighborhoods being less likely to visit primary care physicians or cardiologists in the year following discharge.
- Only 91.6% of patients in the most marginalized areas saw a primary care provider within a year, compared to 96.1% in the least marginalized areas.
- Follow-up with cardiologists also varied significantly, with 75.7% of patients in the most marginalized neighborhoods receiving such care versus 88.0% in the least marginalized areas.
- Patients from marginalized neighborhoods were also less likely to undergo necessary diagnostic testing during the follow-up period, pointing to broader disparities in post-AMI healthcare access.
The study raises important questions about equity in healthcare access and delivery, even in publicly funded systems. The authors note that structural and systemic factors—such as unconscious bias, unmeasured social determinants, and neighborhood-level barriers—may contribute to the gaps in care and outcomes observed.
Although the researchers acknowledge limitations, including the lack of individual-level data on race, income, mental health, or substance use, the findings highlight that universal health coverage alone may not be sufficient to close the outcome gap.
They concluded, "More targeted strategies may be needed to address the underlying social and structural drivers of health inequities, particularly for younger AMI survivors living in disadvantaged communities."
Reference:
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
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