Department of Research & Evaluation News

A study of more than 31,000 Kaiser Permanente members in Southern California showed that Black patients from disadvantaged neighborhoods were significantly more likely to die within 5 years of surviving a heart attack than white patients. In contrast, there was no difference in rates of death between white patients and Black patients who lived in well-resourced neighborhoods.

The study was published in the Journal of the American College of Cardiology.

“All patients in this study had equal access to medical care and were treated at the same medical facilities, but despite comparable health care access, Black patients from lower resourced neighborhoods still had higher mortality compared to white patients,” said the senior author of the research, Mingsum Lee, MD, PhD, a cardiologist with the Kaiser Permanente Los Angeles Medical Center. “This study suggests that social and environmental factors can affect a person’s outcome after a heart attack, and where a person lives can have a powerful impact on health outcomes.”

The researchers analyzed records from 31,275 patients who were treated for a heart attack in a Kaiser Permanente hospital in Southern California between 2006 and 2016. The researchers assigned each patient a neighborhood disadvantage score based on home address using the Area Deprivation Index, a validated index for assessing neighborhood disadvantage based on 17 variables reflecting education, income, employment, and household characteristics. The researchers examined outcomes for each patient over an average of 5 years.

The research revealed significant differences by race, which were differentiated by neighborhood wealth.

• The outcomes for Black patients from well-resourced neighborhoods were similar to white patients from those same neighborhoods.
• Black patients from lower resourced neighborhoods were 19% more likely to die than white patients from those same neighborhoods.

“These findings may be of particular interest to health systems, since most health systems invest heavily to improve the quality of care provided to heart attack patients within the medical system,” Dr. Lee said, “However, what this study shows is that a patient’s post-discharge environment also matters when it comes to long-term health outcomes.”

Among the ways that Kaiser Permanente works to support the communities it serves is the Thriving Communities Fund, which helps to address housing instability and homelessness. In addition, Kaiser Permanente’s ongoing partnerships with community organizations, municipal leaders, and public health champions are working to incorporate health, equity, and sustainability considerations into public policy and the built environment in ways that influence how neighborhoods take shape and grow.

Other authors of the study include Jesse J. Goitia Jr., MD; Derek Q. Phan MD; Franz Schweis, MD; Maereg Wassie, MD; Yuh-Jer Albert Shen, MD, MS, of the Kaiser Permanente Los Angeles Medical Center; and Bryan Lin, MS, formerly of the Department of Research & Evaluation, Kaiser Permanente Southern California in Pasadena, Calif.