Date of Award

January 2024

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Yuan Lu

Second Advisor

Kai Chen


Background: Acute myocardial infarction (AMI) is a leading cause of deaths in women younger than 55 years old. However, current knowledge is limited on how neighborhood deprivation influences the risk of AMI readmission in this population. We evaluated the associations of area deprivation index (ADI) on the risk of readmission 1-year post-AMI in young adults with AMI. Methods: We use data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study- the largest study of young patients with AMI in the US. Neighborhood deprivation was assessed using an ADI score, which was calculated using a Z score of 6 census tract variables and categorized as quartiles. We assessed associations between ADI and the risk of readmission at 1 year post-AMI using sequential cox proportional hazards mixed effects models. We tested unadjusted and adjusted associations across all four ADI quartiles. Heterogeneity by sex was assessed by including an interaction term between sex and ADI in the model. Results: A total of 2,366 patients were included with 1,628 women and 738 men. During the one-year follow-up, 721 readmission events were observed, with higher incidence rates (IR) in more deprived neighborhoods (IR: 25.75 [95% CI: 25.62-25.87] per 1000 person months in quartile 1 vs. IR: 43.58 [95% CI: 43.40-43.77] per 1000 person months in quartile 4). A significant interaction between ADI and sex was observed (P < 0.001). Among younger women with AMI, those living in the most deprived neighborhoods (quartile 4) had a significant higher risk of readmission compared with those living in the least deprived neighborhoods (HR: 1.60 [95% CI: 1.26-2.02], P<0.001). Even after adjusted for demographic and clinical variables, this association remained statistically significant (HR: 1.35 [95% CI: 1.05-1.73]). However, ADI was not significantly associated with readmission at 1 year post- AMI among men (HR in unadjusted model: 1.49 [95% CI: 0.97-2.29], HR in the fully adjusted model: 1.24 [95% CI: 0.80-1.95]). Conclusions: ADI was associated with an increased risk of readmission at 1 year post-AMI in women but not in men. Young women living in the disadvantaged neighborhood experience a 35% higher risk of readmission outcomes than those living in the advantaged neighborhood after 1-year discharge.


This is an Open Access Thesis.

Open Access

This Article is Open Access