doi: 10.1161/CIRCULATIONAHA.105.543231
(Circulation. 2005;112:2634-2641.)
© 2005 American Heart Association, Inc.
Epidemiology |
Mortality After Acute Myocardial Infarction in Hospitals That Disproportionately Treat Black Patients
From the Center for Evaluative Clinical Sciences (J.S., A.C.), Dartmouth Medical School, Hanover, NH; Department of Economics (J.S., A.C., D.S.), Dartmouth College, Hanover, NH; National Bureau of Economics Research (J.S., A.C., D.S.), Cambridge, Mass; Congressional Budget Office (J.L.), Washington, DC; and Center for Health Policy and Center for Primary Care and Outcomes Research (M.M.), Stanford University School of Medicine, Palo Alto, Calif.
Correspondence to Jonathan Skinner, Center for Evaluative Clinical Sciences, Dartmouth Medical School, HB 7251, Hanover, NH 03755. E-mail jonathan.skinner{at}dartmouth.edu
Received February 15, 2005; revision received June 28, 2005; accepted July 8, 2005.
Background— African Americans are more likely to be seen by physicians with less clinical training or to be treated at hospitals with longer average times to acute reperfusion therapies. Less is known about differences in health outcomes. This report compares risk-adjusted mortality after acute myocardial infarction (AMI) between US hospitals with high and low fractions of elderly black AMI patients.
Methods and Results— A prospective cohort study was performed for fee-for-service Medicare patients hospitalized for AMI during 1997 to 2001 (n=1 136 736). Hospitals (n=4289) were classified into approximate deciles depending on the extent to which the hospital served the black population. Decile 1 (12.5% of AMI patients) included hospitals without any black AMI admissions during 1997 to 2001. Decile 10 (10% of AMI patients) included hospitals with the highest fraction of black AMI patients (33.6%). The main outcome measures were 90-day and 30-day mortality after AMI. Patients admitted to hospitals disproportionately serving blacks experienced no greater level of morbidities or severity of the infarction, yet hospitals in decile 10 experienced a risk-adjusted 90-day mortality rate of 23.7% (95% CI 23.2% to 24.2%) compared with 20.1% (95% CI 19.7% to 20.4%) in decile 1 hospitals. Differences in outcomes between hospitals were not explained by income, hospital ownership status, hospital volume, census region, urban status, or hospital surgical treatment intensity.
Conclusions— Risk-adjusted mortality after AMI is significantly higher in US hospitals that disproportionately serve blacks. A reduction in overall mortality at these hospitals could dramatically reduce black-white disparities in healthcare outcomes.
Key Words: death, sudden • myocardial infarction • hospitals • outcomes • race
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