Going Back To Understand the Future: Socioeconomic Position and Survival after Myocardial Infarction

Do we really need another paper on socioeconomic inequalities in health? After all, we have known for decades (or centuries, as some would say [1]) that, for most health outcomes, the rich do better and the poor do worse (2). After a literature search (3), I found that the rate at which articles were being published on this topic was more than 300 papers per month. When I recently updated the search, the exponential increase in publications had not abated in the slightest. We hear whispers of “enough studies, it's time to intervene,” and yet more and more submissions arrive on the desks of journal editors and reviewers.

Current research on socioeconomic disparities in health can be grouped into 3 main areas. First, many studies are further documenting the association between socioeconomic position and health. Second, numerous studies seek the reasons for the association. Within this domain, some offer explanations that invoke poverty and material conditions on the one hand and psychosocial factors, such as control or depression, on the other (4); others examine the role of behavioral and biological pathways that link socioeconomic position and health (5). Other studies that fall into this category have investigated the causes of socioeconomic inequalities throughout the course of life, perhaps even starting in utero (6); the contribution of neighborhoods and communities to disparities (7); and, of course, the role of access and quality of medical care (8). Third, other studies have examined interventions to reduce income-related disparities in health outcomes; this category has far fewer examples.

In this issue, Alter and colleagues (9) seek explanations by using data from a cohort of almost 5000 Canadian patients who were hospitalized after myocardial infarction (MI). The researchers examined the association between income and 2-year survival after MI. They focused on how demographic …