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Heart Attack Care Often Delayed for the Poor
Date:9/22/2008

nd those living in low-income areas were relatively more likely to experience a long or medium delay in getting to the hospital for heart attack care.

For example, patients residing in lower-income neighborhoods were 46 percent more likely to experience a long rather than a short delay in getting to a hospital after heart attack, the study found. And patients on Medicaid were 87 percent more likely to wait a long time before having their symptoms seen to, the team reported.

Why the disparity based on income? The researchers aren't sure. They noted that one factor -- a lack of health insurance -- didn't seem to affect wait times.

"From a public health standpoint these disparities should be further investigated," said Foraker. "And in the meantime, to reduce these disparities, one of the targets may be to increase the recognition of symptoms of a heart attack. And to promote EMS use throughout the community, so people know to call an ambulance right away when they experience these symptoms."

One expert expressed little surprise at the findings.

"As to why this might be so, it seems to me that there is a sort of mystery component to any relationship between income and delay," said Dr. Marshall Morgan, chief of emergency medicine at the Ronald Reagan UCLA Medical Center in Los Angeles. "Recognizing symptoms is key, and I could suggest that although there has been more of an effort in recent years to educate the public about heart attack symptom recognition, this campaign may have penetrated well among the better-educated and less well among the less well-educated. And, of course, there's no question that economic status and education go together.

"It's also important to note that most ambulances are a public service," Morgan added. "So, while emergency services personnel get paid the same whether transporting a rich person or a poorer person, it might be that certain zip codes have a lower distribution of ambu
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