(Circulation. 2000;102:642.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Race, Sex, Poverty, and the Medical Treatment of Acute Myocardial Infarction in the Elderly
From the Clinical Economics Research Unit (S.S.R., A.K.B., K.P.W., K.A.S.), the Division of Cardiology (A.K.B., B.J.G.), and the Institute for Health Care Research and Policy (M.F.), Georgetown University Medical Center, Washington, DC; Maryland HealthCare Associates, LLC, Clinton, Md, and the Delmarva Foundation for Medical Care, Inc., Easton, Md (W.J.O.). Mr Rathore is now at the University of North Carolina School of Public Health, Chapel Hill. Dr Berger is now at the Division of Cardiology, Yale-New Haven Medical Center, New Haven, Conn. Drs. Weinfurt and Schulman are now at the Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. Dr Gersh is now at the Cardiovascular Diseases Division, Mayo Clinic, Rochester, Minn.
Correspondence to Dr Schulman, Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University Medical Center, PO Box 17969, Durham, NC 27715. E-mail schul012{at}mc.duke.edu
Background—Race, sex, and poverty are associated with the use of diagnostic cardiac catheterization and coronary revascularization during treatment of acute myocardial infarction (AMI). However, the association of sociodemographic characteristics with the use of less costly, more readily available medical therapies remains poorly characterized.
Methods and Results—We evaluated 169 079 Medicare beneficiaries
65 years of age treated for AMI between January 1994 and February
1996 to determine the association of patient race, sex, and poverty
with the use of medical therapy. Multivariable regression models
were constructed to evaluate the unadjusted and adjusted influence of
sociodemographic characteristics on the use of 2 admission (aspirin,
reperfusion) and 2 discharge therapies (aspirin, ß-blockers)
indicated during the treatment of AMI. Therapy use varied by patient
race, sex, and poverty status. Black patients were less likely to
undergo reperfusion (RR 0.84, 95% CI 0.78, 0.91) or receive aspirin on
admission (RR 0.97, 95% CI 0.96, 0.99) and ß-blockers (RR 0.94, 95%
CI 0.88, 1.00) at discharge. Female patients were less likely to
receive aspirin on admission (RR 0.98, 95% CI 0.97, 0.99) and
discharge (RR 0.98, 95% CI 0.96, 0.99). Poor patients were less likely
to receive aspirin (RR 0.97, 95% CI 0.96, 0.98) or reperfusion (RR
0.97, 95% CI 0.93, 1.00) on admission and aspirin (RR 0.98, 95% CI
0.96, 1.00), or ß-blockers (RR 0.95, 95% CI 0.91, 0.99) on
discharge.
Conclusions—Medical therapies are currently underused in the treatment of black, female, and poor patients with AMI.
Key Words: myocardial infarction • sex • outcomes • race
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