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Poverty is a number 1 killer

Harold Mandel's picture
A poor homeless American man

Poverty is a number one killer across the United States and worldwide. Research shows poverty has a direct impact on outcomes of heart attack victims. Advancements in understandings of how to avoid heart disease with better diets, more exercise, and cessation of smoking are helping in prevention efforts in dealing with heart attacks. New research which shows an association between poverty and the severity of heart attacks leads to another consideration that it's a good idea to support the interests of people in being well off financially if you are sincere about wanting to help them have healthy hearts and lead a long, productive and happy life.

Researchers have investigated the predictive value of socioeconomic factors in the development of post-myocardial infarction frailty, reports the International Journal of Cardiology. They found that socioeconomic status demonstrates a clear relationship with post-myocardial infarction outcomes, which is also associated with community frailty.

The researchers followed 1151 post-myocardial infarction patients from initial hospitalization in 1992–1993 for 10–13 years. The individual and neighborhood socioeconomic status measures of the patients were assessed at baseline and frailty was assessed during follow-up. At follow-up 399 patients, or 35 percent, developed frailty. It was observed that individual and neighborhood socioeconomic status were significantly and independently associated with the risk of developing frailty.

Low income patients have a higher risk of becoming frail

The low income patients were found to have twice the risk of becoming frail in comparison with those patients with high income. Being in the lower versus upper neighborhood socioeconomic status was associated with a 60 percent increased odds. It was therefore concluded by the researchers that individual and neighborhood socioeconomic factors have an impact on the development of frailty post-myocardial infarction and contribute to risk in this population of patients.

These researchers have therefore shown that socioeconomic status is a predictor of higher risk of disease and death after an heart attack, reports Tel Aviv University in a discussion of this research on Jan. 8, 2014. It has been consistently observed that as people get older, their bodies wear down and become less resilient. It is common for people in their old age to become what is seen as "clinically frail." This "frailty syndrome" has been emerging in the field of public health as a powerful predictor of healthcare use and death.

Researchers Vicki Myers and Professor Yariv Gerber of the Department of Epidemiology and Preventive Medicine at the School of Public Health at Tel Aviv University's Sackler Faculty of Medicine and colleagues have discovered that poor people are greater than twice as likely as wealthy people to become frail after a heart attack. Doctors and policymakers could work to improve post-heart-attack care for the poor using these findings.

Myers has said, "By defining frailty, which combines many areas of medicine, we can predict which people are at the highest risk after a heart attack. And we found a strong connection between frailty and socioeconomic status." The definition of frailty includes physical, psychological, and functional aspects. This can be effectively diagnosed by observing an accumulation of health problems in any given individual. Ms. Myers and her colleagues have therefore created an index of 40 health-related variables, which have been shown to be effective in diagnosing frailty in heart attack patients.

The researchers applied the index to 1,151 patients who had suffered heart attacks in central Israel from 10 to 13 years prior to the study, using medical records and interviews. The primary health problems seen in these patients were:

1: Type-2 diabetes

2: Physical inactivity

3: Lack of energy

4: Work limitations

5: Limitation climbing stairs

6: Self-rated health deterioration.

This index was also used to assess the presence of:

1: A range of diseases

2: Significant weight loss

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3: Limitations to activities of daily living

4: Anxiety

5: Depression

6: Pain

The researchers discovered that 35 percent of the patients who were in the study had become frail in the decade which followed their heart attack. The patients who were frail were more likely to have suffered a severe heart attack and to have been older and obese when they were first evaluated in 1992 to 1993, just after they had heart attacks. These patients were also more likely to have had a lower socioeconomic status, with fewer years of education and lower overall family income, to have been unemployed, and to have lived in a poor neighborhood in Israel.

Aside from being simply sicker overall, frail patients were also not as likely to have been admitted to intensive care, to have undergone surgery, or to have been prescribed certain medications which are commonly prescribed after a heart attack. Myers said, "Not only was low income associated with twice the risk of becoming frail, living in a deprived neighborhood was linked to a 60 percent increased risk of frailty compared to living in a wealthy neighborhood, irrespective of personal circumstances." It is possible according to the researchers that these findings may reflect poorer access to healthcare among the poor.

Poor health has been associated with low socioeconomic status in many ways. Poor people overall have been observed to share risk factors such as:

1: Less access to healthcare

2: Lower health literacy

3: A higher prevalence of risk factors, like smoking, inactivity, and unhealthy diet.

In spite of a myriad of theories, it is not exactly certain at this time how socioeconomic status affects health after a heart attack in particular. Myers and her colleagues hope to give doctors and decision-makers a more sound basis on which to make healthcare decisions with this convincing evidence showing an association between socioeconomic status and frailty after a heart attack.

Doctors should take a more holistic view of patients

These researchers have recommended initiatives aimed at preventing frailty after a heart attack among high-risk groups. They have also suggested additional healthcare services in disadvantaged areas to address socioeconomic inequalities, with a particular focus on cardiac rehabilitation. It is also their position that doctors should take a more holistic view of patients after they suffer a heart attack in order to help prevent frailty and its associated risks.

From my personal experience, it has become clear that socioeconomic factors have a direct impact on a range of health care concerns. The finding in this research that poor socioeconomic status is associated with greater frailty and poorer outcomes after a heart attack is therefore not surprising. However, this research is significant because it helps to drive home the vital importance of recognizing this association.

Far too often I have heard some not very nice people who are arrogant about their extreme wealth and power in society insist to those who were not born into such wealth that they have their priorities upside down when they insist a priority in their life is to try hard to get wealthy. The old cliche that wealth can not buy you happiness is a cruel and sadistic position to impress upon poor people who want to get ahead financially in life, particularly in view of the fact that poverty is clearly directly associated with poor health.

It's true, there are many people who are very wealthy who are not very happy, such as we often read about in Hollywood gossip columns. However, shared unhappiness about our mortality and other horrible conditions in the world is to be expected. Nevertheless, it is clearly easier on the human condition to experience such bouts of unhappiness and frustration in life in comfort instead of the squalor of poverty and disease.

Certainly therefore the wealthy can also be expected to at least experience some added moments of joy in life, which is also a critical factor in a proper assessment of overall health and well being. Therefore in a proper consideration of prevention of cardiac disease and other illness, in a humane society there must be more initiatives not just to attack poverty, but also to generate more wealth for more people.

I often get the feeling far too many of our societies policies create and enforce poverty. I see this as being particularly true with psychiatrists and other doctors and nurses who work with them, who constantly throw potentially productive lives away in the trash instead of working hard to nurture the most out of every person's potential in life.

The bottom line is intentionally neglecting poverty and the need for the creation of more wealth for more people is cold blooded sadistic murder, no matter how you look at it. In any society which insists it is civilized there must be a shared responsibility to directly confront these issues. The poor feel the pain of this reality of being slowly murdered daily. It is therefore understandable why the poor often buy lottery tickets to try to beat poverty, reports EmaxHealth reporter Armen Hareyan.