Differences in mortality and use of revascularization in black and white patients with acute MI admitted to hospitals with and without revascularization services

被引:88
作者
Popescu, Ioana
Vaughan-Sarrazin, Mary S.
Rosenthal, Gary E.
机构
[1] Univ Iowa, Carver Coll Med, Dept Internal Med, Div Gen Internal Med, Iowa City, IA USA
[2] Iowa City VA Med Ctr, Ctr Res Implementat Innovat Strategies Practice, Iowa City, IA USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2007年 / 297卷 / 22期
关键词
D O I
10.1001/jama.297.22.2489
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context Racial differences in the use of coronary revascularization after acute myocardial infarction ( AMI) have been widely reported. However, few studies have examined patterns of care for AMI patients admitted to hospitals with and without revascularization services. Objective To compare rates of hospital transfer, coronary revascularization, and mortality after AMI for black and white patients admitted to hospitals with and without revascularization services. Design, Setting, and Participants Retrospective cohort study of 1 215 924 black and white Medicare beneficiaries aged 68 years and older, admitted with AMI between January 1, 2000, and June 30, 2005, to 4627 US hospitals with and without revascularization services. Main Outcome Measures For patients admitted to nonrevascularization hospitals, transfer to another hospital with revascularization services; for all patients, risk-adjusted rates of 30-day coronary revascularization and 1-year mortality. Results Black patients admitted to hospitals without revascularization were less likely (25.2% vs 31.0%; P <. 001) to be transferred. Black patients admitted to hospitals with or without revascularization services were less likely to undergo revascularization than white patients (34.3% vs 50.2% and 18.3% vs 25.9%; P <. 001) and had higher 1-year mortality (35.3% vs 30.2% and 39.7% vs 37.6%; P <. 001). After adjustment for sociodemographics, comorbidity, and illness severity, blacks remained less likely to be transferred ( hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.75-0.81; P <. 001) and undergo revascularization ( HR, 0.71; 95% CI, 0.69-0.74; P <. 001; and HR, 0.68; 95% CI, 0.65-0.70; P <. 001 in hospitals with and without revascularization, respectively). Risk-adjusted mortality was lower for blacks during the first 30 days after admission ( HR, 0.91; 95% CI, 0.88-0.93; P <. 001; and HR, 0.90; 95% CI, 0.87-0.92; P <. 001 in hospitals with and without revascularization, respectively) but was higher ( P <. 001) thereafter. Conclusions Black patients admitted to hospitals with and without coronary revascularization services are less likely to receive coronary revascularization. The higher long-term mortality of black patients may reflect the lower use of revascularization or other aspects of AMI care.
引用
收藏
页码:2489 / 2495
页数:7
相关论文
共 35 条
  • [1] Thrombolytic therapy vs primary percutaneous coronary intervention for myocardial infarction in patients presenting to hospitals without on-site cardiac surgery - A randomized controlled trial
    Aversano, T
    Aversano, LT
    Passamani, E
    Knatterud, GL
    Terrin, ML
    Williams, DO
    Forman, SA
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2002, 287 (15): : 1943 - 1951
  • [2] RACIAL-DIFFERENCES IN THE USE OF REVASCULARIZATION PROCEDURES AFTER CORONARY ANGIOGRAPHY
    AYANIAN, JZ
    UDVARHELYI, IS
    GATSONIS, CA
    PASHOS, CL
    EPSTEIN, AM
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1993, 269 (20): : 2642 - 2646
  • [3] SEQUENTIAL EVENTS CONTRIBUTING TO VARIATIONS IN CARDIAC REVASCULARIZATION RATES
    BLUSTEIN, J
    ARONS, RR
    SHEA, S
    [J]. MEDICAL CARE, 1995, 33 (08) : 864 - 880
  • [4] Racial and ethnic differences in time to acute reperfusion therapy for patients hospitalized with myocardial infarction
    Bradley, EH
    Herrin, J
    Wang, YF
    McNamara, RL
    Webster, TR
    Magid, DJ
    Blaney, M
    Peterson, ED
    Canto, JG
    Pollack, CV
    Krumholz, HM
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2004, 292 (13): : 1563 - 1572
  • [5] Relation of race and sex to the use of reperfusion therapy in medicare beneficiaries with acute myocardial infarction.
    Canto, JG
    Allison, JJ
    Kiefe, CI
    Fincher, C
    Farmer, R
    Sekar, P
    Person, S
    Weissman, NW
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2000, 342 (15) : 1094 - 1100
  • [6] Understanding racial variation in the use of coronary revascularization procedures - The role of clinical factors
    Conigliaro, J
    Whittle, J
    Good, CB
    Hanusa, BH
    Passman, LJ
    Lofgren, RP
    Allman, R
    Ubel, PA
    O'Connor, M
    Macpherson, DS
    [J]. ARCHIVES OF INTERNAL MEDICINE, 2000, 160 (09) : 1329 - 1335
  • [7] Comorbidity measures for use with administrative data
    Elixhauser, A
    Steiner, C
    Harris, DR
    Coffey, RN
    [J]. MEDICAL CARE, 1998, 36 (01) : 8 - 27
  • [8] Racial and ethnic differences in the use of cardiovascular procedures: Findings from the California Cooperative Cardiovascular Project
    Ford, E
    Newman, J
    Deosaransingh, K
    [J]. AMERICAN JOURNAL OF PUBLIC HEALTH, 2000, 90 (07) : 1128 - 1134
  • [9] RACE-DIFFERENCES AND SEX-DIFFERENCES IN RATES OF INVASIVE CARDIAC PROCEDURES IN US-HOSPITALS - DATA FROM THE NATIONAL HOSPITAL DISCHARGE SURVEY
    GILES, WH
    ANDA, RF
    CASPER, ML
    ESCOBEDO, LG
    TAYLOR, HA
    [J]. ARCHIVES OF INTERNAL MEDICINE, 1995, 155 (03) : 318 - 324
  • [10] Racial variation in predicted and observed in-hospital death - A regional analysis
    Gordon, HS
    Harper, DL
    Rosenthal, GE
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1996, 276 (20): : 1639 - 1644