Perspective:

This analysis attempts to examine the contemporary role of SES in STEMI outcomes and resource utilization using data from the Nationwide Inpatient Sample (NIS). The findings are not surprising and are consistent with prior work: Patients in poorer zip codes have worse outcomes and use fewer resources. In general, the paper is well-written and the authors provide a new overview of the long literature on disparities in cardiovascular diseases and acute myocardial infarction (AMI). However, the paper does have a few key limitations, which the authors readily acknowledge. The use of administrative data in the NIS limits their ability to detect STEMI (as opposed to AMI), identify timely reperfusion therapy (as opposed to the receipt of any reperfusion therapy), and identify the role of individual SES (as opposed to group SES at the zip code level). These concerns limit the ability to measure the true extent of disparities (because of misclassification), and to understand potential mechanisms by which worse outcomes may be occurring in this group (e.g., individual vs. neighborhood factors). These limitations aside, the continued growth in socioeconomic disparities across the United States makes such work even more important as providers aim to equitably deliver the promise of high-quality cardiovascular care to more patients.