Abstract 4363589: Neighborhood-Level Gentrification and Rates of ST-Elevation Myocardial Infarction

Abstract

Background: Despite advances in preventive cardiology, there remain differences in ST Elevation Myocardial Infarction (STEMI) rates among certain populations and across neighborhoods. While gentrification is an important neighborhood-level factor that may contribute to disparities, no studies have examined the relationship between gentrification and STEMI. We sought to analyze the change in STEMI rates over time for gentrifying neighborhoods compared to non-gentrifying, stably low-SES neighborhoods. Methods: This retrospective cohort study included all emergency medical service STEMI activations occurring within low-SES census tracts (i.e. tracts susceptible to gentrification) in Los Angeles County from 2011-2019. Low-SES tracts that did or did not gentrify in 2015-2019 were defined using American Community Survey data following methods from the Urban Displacement Project. The outcome was rate of STEMI activations per 1000 tract residents. Multivariable Poisson regression was performed to assess the association of gentrification with change in STEMI rates between baseline (2011-2014) and follow-up (2015-2019), adjusted for demographics. As displacement is an inherent characteristic of gentrification, we performed subgroup analyses comparing tracts with the lowest and highest quartiles of geographic mobility, a characteristic sourced from the American Community Survey. Results: A total of 868 low-SES census tracts in Los Angeles County were included, of which 128 gentrified in the 2015-2019 time period while 740 remained low-SES. Multivariable analysis found no significant change in STEMI rates in gentrifying versus stably low-SES tracts. Subgroup analysis found that among tracts in the highest quartile of mobility (213 tracts), STEMI rates were 35% higher in gentrifying versus stably low-SES tracts (95% CI 19%-54%), with no differences in low-mobility tracts. Conclusion: There was no significant association between gentrification and neighborhood STEMI rates. However, among neighborhoods with high levels of displacement, STEMI rates were higher among gentrifying tracts. Changing group composition due to displacement may result in declining social cohesion among remaining residents, which is a known protective factor against myocardial infarction. Future work is needed to clarify this relationship, understand subgroups that differentially experience gentrification, and determine mechanisms through which gentrification affects cardiovascular health.