Importance Socioeconomic disadvantage is associated with poor health outcomes. However, whether socioeconomic factors are associated with post–myocardial infarction (MI) outcomes in younger patient populations is unknown.

Objective To evaluate the association of neighborhood-level socioeconomic disadvantage with long-term outcomes among patients who experienced an MI at a young age.

Design, Setting, and Participants This cohort study analyzed patients in the Mass General Brigham YOUNG-MI Registry (at Brigham and Women’s Hospital and Massachusetts General Hospital in Boston, Massachusetts) who experienced an MI at or before 50 years of age between January 1, 2000, and April 30, 2016. Each patient’s home address was mapped to the Area Deprivation Index (ADI) to capture higher rates of socioeconomic disadvantage. The median follow-up duration was 11.3 years. The dates of analysis were May 1, 2020, to June 30, 2020.

Exposures Patients were assigned an ADI ranking according to their home address and then stratified into 3 groups (least disadvantaged group, middle group, and most disadvantaged group).

Main Outcomes and Measures The outcomes of interest were all-cause and cardiovascular mortality. Cause of death was adjudicated from national registries and electronic medical records. Cox proportional hazards regression modeling was used to evaluate the association of ADI with all-cause and cardiovascular mortality.

Results The cohort consisted of 2097 patients, of whom 2002 (95.5%) with an ADI ranking were included (median [interquartile range] age, 45 [42-48] years; 1607 male individuals [80.3%]). Patients in the most disadvantaged neighborhoods were more likely to be Black or Hispanic, have public insurance or no insurance, and have higher rates of traditional cardiovascular risk factors such as hypertension and diabetes. Among the 1964 patients who survived to hospital discharge, 74 (13.6%) in the most disadvantaged group compared with 88 (12.6%) in the middle group and 41 (5.7%) in the least disadvantaged group died. Even after adjusting for a comprehensive set of clinical covariates, higher neighborhood disadvantage was associated with a 32% higher all-cause mortality (hazard ratio, 1.32; 95% CI, 1.10-1.60; P = .004) and a 57% higher cardiovascular mortality (hazard ratio, 1.57; 95% CI, 1.17-2.10; P = .003).

Conclusions and Relevance This study found that, among patients who experienced an MI at or before age 50 years, socioeconomic disadvantage was associated with higher all-cause and cardiovascular mortality even after adjusting for clinical comorbidities. These findings suggest that neighborhood and socioeconomic factors have an important role in long-term post-MI survival.

重要性 社会经济劣势与健康状况不佳有关。然而，社会经济因素是否与年轻患者群体的心肌梗死 (MI) 预后相关尚不清楚。

目的 评估在年轻时经历 MI 的患者社区层面的社会经济劣势与长期预后的关系。

设计、环境和参与者 该队列研究分析了麻省总医院 Brigham YOUNG-MI 登记处（位于马萨诸塞州波士顿的布莱根妇女医院和马萨诸塞州总医院）在 1 月 1 日或 50 岁或之前经历 MI 的患者， 2000 年和 2016 年 4 月 30 日。每个患者的家庭住址都被映射到地区剥夺指数 (ADI)，以捕捉更高的社会经济劣势率。中位随访时间为 11.3 年。分析日期为 2020 年 5 月 1 日至 2020 年 6 月 30 日。

暴露 患者根据他们的家庭住址被分配一个 ADI 排名，然后分为 3 组（最不利的组、中间组和最不利的组）。

主要结果和测量 感兴趣的结果是全因死亡率和心血管死亡率。死因是根据国家登记和电子病历判定的。Cox 比例风险回归模型用于评估 ADI 与全因死亡率和心血管死亡率的关系。

结果 该队列由 2097 名患者组成，其中 2002 名（95.5%）具有 ADI 排名（中位 [四分位距] 年龄，45 [42-48] 岁；1607 名男性 [80.3%]）。最弱势社区的患者更有可能是黑人或西班牙裔，有公共保险或没有保险，并且高血压和糖尿病等传统心血管危险因素的发生率更高。在存活至出院的1964例患者中，最不利组74例（13.6%）死亡，中间组88例（12.6%），最不利组41例（5.7%）死亡。即使在调整了一组全面的临床协变量后，较高的邻里劣势与高 32% 的全因死亡率相关（风险比，1.32；95% CI，1.10-1.60；P = .004），心血管死亡率增加 57%（风险比，1.57；95% CI，1.17-2.10；P  = .003）。

结论和相关性 本研究发现，在 50 岁或之前发生 MI 的患者中，即使在调整了临床合并症后，社会经济劣势与更高的全因死亡率和心血管死亡率相关。这些研究结果表明，邻里和社会经济因素在 MI 后的长期生存中具有重要作用。