Sex and Racial Differences in the Management of Acute Myocardial Infarction, 1994 through 2002
This study compared treatments and outcomes after myocardial infarction according to sex and race from 1994 through 2002. As compared with white men, black men and both white and black women had lower rates of reperfusion therapy and coronary angiography, and black women had higher mortality. Sex an...
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| Published in: | The New England journal of medicine Vol. 353; no. 7; pp. 671 - 682 |
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| Main Authors: | , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Boston, MA
Massachusetts Medical Society
18-08-2005
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| Abstract | This study compared treatments and outcomes after myocardial infarction according to sex and race from 1994 through 2002. As compared with white men, black men and both white and black women had lower rates of reperfusion therapy and coronary angiography, and black women had higher mortality. Sex and racial differences did not change substantially between 1994 and 2002.
As compared with white men, black men and both white and black women had lower rates of reperfusion therapy and coronary angiography, and black women had higher mortality.
In recent years, attention has been focused on variations in the treatment of coronary heart disease that are related to the sex and race of the patient. Landmark studies in the late 1980s and early 1990s reported differences in treatment according to sex and race.
1
–
4
In the past decade, other investigations have described a generally consistent pattern of less intensive treatment of acute myocardial infarction in women, as compared with men,
5
–
11
and in blacks, as compared with whites,
8
,
9
,
12
–
17
across a variety of settings. Efforts to remedy racial and sex differences in health care use have . . . |
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| AbstractList | Background Although increased attention has been paid to sex and racial differences in the management of myocardial infarction, it is unknown whether these differences have narrowed over time. Methods With the use of data from the National Registry of Myocardial Infarction, we examined sex and racial differences in the treatment of patients who were deemed to be "ideal candidates" for particular treatments and in deaths among 598,911 patients hospitalized with myocardial infarction between 1994 and 2002. Results In the unadjusted analysis, sex and racial differences were observed for rates of reperfusion therapy (for white men, white women, black men, and black women: 86.5, 83.3, 80.4, and 77.8 percent, respectively; P<0.001), use of aspirin (84.4, 78.7, 83.7, and 78.4 percent, respectively; P<0.001), use of beta-blockers (66.6, 62.9, 67.8, and 64.5 percent; P<0.001), and coronary angiography (69.1, 55.9, 64.0, and 55.0 percent; P<0.001). After multivariable adjustment, racial and sex differences persisted for rates of reperfusion therapy (risk ratio for white women, black men, and black women: 0.97, 0.91, and 0.89, respectively, as compared with white men) and coronary angiography (relative risk, 0.91, 0.82, and 0.76) but were attenuated for the use of aspirin (risk ratio, 0.97, 0.98, and 0.94) and beta-blockers (risk ratio, 0.98, 1.00, and 0.96); all risks were unchanged over time. Adjusted in-hospital mortality was similar among white women (risk ratio, 1.05; 95 percent confidence interval, 1.03 to 1.07) and black men (risk ratio, 0.95; 95 percent confidence interval, 0.89 to 1.00), as compared with white men, but was higher among black women (risk ratio, 1.11; 95 percent confidence interval, 1.06 to 1.16) and was unchanged over time. Conclusions Rates of reperfusion therapy, coronary angiography, and in-hospital death after myocardial infarction, but not the use of aspirin and beta-blockers, vary according to race and sex, with no evidence that the differences have narrowed in recent years. Although increased attention has been paid to sex and racial differences in the management of myocardial infarction, it is unknown whether these differences have narrowed over time. With the use of data from the National Registry of Myocardial Infarction, we examined sex and racial differences in the treatment of patients who were deemed to be "ideal candidates" for particular treatments and in deaths among 598,911 patients hospitalized with myocardial infarction between 1994 and 2002. In the unadjusted analysis, sex and racial differences were observed for rates of reperfusion therapy (for white men, white women, black men, and black women: 86.5, 83.3, 80.4, and 77.8 percent, respectively; P<0.001), use of aspirin (84.4, 78.7, 83.7, and 78.4 percent, respectively; P<0.001), use of beta-blockers (66.6, 62.9, 67.8, and 64.5 percent; P<0.001), and coronary angiography (69.1, 55.9, 64.0, and 55.0 percent; P<0.001). After multivariable adjustment, racial and sex differences persisted for rates of reperfusion therapy (risk ratio for white women, black men, and black women: 0.97, 0.91, and 0.89, respectively, as compared with white men) and coronary angiography (relative risk, 0.91, 0.82, and 0.76) but were attenuated for the use of aspirin (risk ratio, 0.97, 0.98, and 0.94) and beta-blockers (risk ratio, 0.98, 1.00, and 0.96); all risks were unchanged over time. Adjusted in-hospital mortality was similar among white women (risk ratio, 1.05; 95 percent confidence interval, 1.03 to 1.07) and black men (risk ratio, 0.95; 95 percent confidence interval, 0.89 to 1.00), as compared with white men, but was higher among black women (risk ratio, 1.11; 95 percent confidence interval, 1.06 to 1.16) and was unchanged over time. Rates of reperfusion therapy, coronary angiography, and in-hospital death after myocardial infarction, but not the use of aspirin and beta-blockers, vary according to race and sex, with no evidence that the differences have narrowed in recent years. Although increased attention has been paid to sex and racial differences in the management of myocardial infarction, it is unknown whether these differences have narrowed over time.BACKGROUNDAlthough increased attention has been paid to sex and racial differences in the management of myocardial infarction, it is unknown whether these differences have narrowed over time.With the use of data from the National Registry of Myocardial Infarction, we examined sex and racial differences in the treatment of patients who were deemed to be "ideal candidates" for particular treatments and in deaths among 598,911 patients hospitalized with myocardial infarction between 1994 and 2002.METHODSWith the use of data from the National Registry of Myocardial Infarction, we examined sex and racial differences in the treatment of patients who were deemed to be "ideal candidates" for particular treatments and in deaths among 598,911 patients hospitalized with myocardial infarction between 1994 and 2002.In the unadjusted analysis, sex and racial differences were observed for rates of reperfusion therapy (for white men, white women, black men, and black women: 86.5, 83.3, 80.4, and 77.8 percent, respectively; P<0.001), use of aspirin (84.4, 78.7, 83.7, and 78.4 percent, respectively; P<0.001), use of beta-blockers (66.6, 62.9, 67.8, and 64.5 percent; P<0.001), and coronary angiography (69.1, 55.9, 64.0, and 55.0 percent; P<0.001). After multivariable adjustment, racial and sex differences persisted for rates of reperfusion therapy (risk ratio for white women, black men, and black women: 0.97, 0.91, and 0.89, respectively, as compared with white men) and coronary angiography (relative risk, 0.91, 0.82, and 0.76) but were attenuated for the use of aspirin (risk ratio, 0.97, 0.98, and 0.94) and beta-blockers (risk ratio, 0.98, 1.00, and 0.96); all risks were unchanged over time. Adjusted in-hospital mortality was similar among white women (risk ratio, 1.05; 95 percent confidence interval, 1.03 to 1.07) and black men (risk ratio, 0.95; 95 percent confidence interval, 0.89 to 1.00), as compared with white men, but was higher among black women (risk ratio, 1.11; 95 percent confidence interval, 1.06 to 1.16) and was unchanged over time.RESULTSIn the unadjusted analysis, sex and racial differences were observed for rates of reperfusion therapy (for white men, white women, black men, and black women: 86.5, 83.3, 80.4, and 77.8 percent, respectively; P<0.001), use of aspirin (84.4, 78.7, 83.7, and 78.4 percent, respectively; P<0.001), use of beta-blockers (66.6, 62.9, 67.8, and 64.5 percent; P<0.001), and coronary angiography (69.1, 55.9, 64.0, and 55.0 percent; P<0.001). After multivariable adjustment, racial and sex differences persisted for rates of reperfusion therapy (risk ratio for white women, black men, and black women: 0.97, 0.91, and 0.89, respectively, as compared with white men) and coronary angiography (relative risk, 0.91, 0.82, and 0.76) but were attenuated for the use of aspirin (risk ratio, 0.97, 0.98, and 0.94) and beta-blockers (risk ratio, 0.98, 1.00, and 0.96); all risks were unchanged over time. Adjusted in-hospital mortality was similar among white women (risk ratio, 1.05; 95 percent confidence interval, 1.03 to 1.07) and black men (risk ratio, 0.95; 95 percent confidence interval, 0.89 to 1.00), as compared with white men, but was higher among black women (risk ratio, 1.11; 95 percent confidence interval, 1.06 to 1.16) and was unchanged over time.Rates of reperfusion therapy, coronary angiography, and in-hospital death after myocardial infarction, but not the use of aspirin and beta-blockers, vary according to race and sex, with no evidence that the differences have narrowed in recent years.CONCLUSIONSRates of reperfusion therapy, coronary angiography, and in-hospital death after myocardial infarction, but not the use of aspirin and beta-blockers, vary according to race and sex, with no evidence that the differences have narrowed in recent years. This study compared treatments and outcomes after myocardial infarction according to sex and race from 1994 through 2002. As compared with white men, black men and both white and black women had lower rates of reperfusion therapy and coronary angiography, and black women had higher mortality. Sex and racial differences did not change substantially between 1994 and 2002. As compared with white men, black men and both white and black women had lower rates of reperfusion therapy and coronary angiography, and black women had higher mortality. In recent years, attention has been focused on variations in the treatment of coronary heart disease that are related to the sex and race of the patient. Landmark studies in the late 1980s and early 1990s reported differences in treatment according to sex and race. 1 – 4 In the past decade, other investigations have described a generally consistent pattern of less intensive treatment of acute myocardial infarction in women, as compared with men, 5 – 11 and in blacks, as compared with whites, 8 , 9 , 12 – 17 across a variety of settings. Efforts to remedy racial and sex differences in health care use have . . . |
| Author | Vaccarino, Viola Krumholz, Harlan M Abramson, Jerome L Barron, Hal V Manhapra, Ajay Frederick, Paul D Mallik, Susmita Wenger, Nanette K Rathore, Saif S |
| Author_xml | – sequence: 1 givenname: Viola surname: Vaccarino fullname: Vaccarino, Viola – sequence: 2 givenname: Saif S surname: Rathore fullname: Rathore, Saif S – sequence: 3 givenname: Nanette K surname: Wenger fullname: Wenger, Nanette K – sequence: 4 givenname: Paul D surname: Frederick fullname: Frederick, Paul D – sequence: 5 givenname: Jerome L surname: Abramson fullname: Abramson, Jerome L – sequence: 6 givenname: Hal V surname: Barron fullname: Barron, Hal V – sequence: 7 givenname: Ajay surname: Manhapra fullname: Manhapra, Ajay – sequence: 8 givenname: Susmita surname: Mallik fullname: Mallik, Susmita – sequence: 9 givenname: Harlan M surname: Krumholz fullname: Krumholz, Harlan M |
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| Snippet | This study compared treatments and outcomes after myocardial infarction according to sex and race from 1994 through 2002. As compared with white men, black men... Although increased attention has been paid to sex and racial differences in the management of myocardial infarction, it is unknown whether these differences... Background Although increased attention has been paid to sex and racial differences in the management of myocardial infarction, it is unknown whether these... |
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| SubjectTerms | Adrenergic beta-Antagonists - therapeutic use Aged Angioplasty Aspirin - therapeutic use Biological and medical sciences Black or African American Black People Cardiology. Vascular system Cardiovascular disease Coronary Angiography - statistics & numerical data Coronary heart disease Female General aspects Health Services Accessibility Heart Heart attacks Hospital Mortality Hospitalization Hospitals Humans Logistic Models Male Medical imaging Medical sciences Middle Aged Myocardial Infarction - ethnology Myocardial Infarction - therapy Myocardial Revascularization - statistics & numerical data Platelet Aggregation Inhibitors - therapeutic use Process Assessment, Health Care Quality of Health Care Race Racial differences Risk Factors Sex Factors United States White People |
| Title | Sex and Racial Differences in the Management of Acute Myocardial Infarction, 1994 through 2002 |
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