Abstract 3172: Changes in Socioeconomic and Ethnic Disparities in the Use of Invasive Cardiac Procedures in Acute Myocardial Infarction Patients from 1995 to 2006
Socioeconomic and ethnic disparities in the use of invasive cardiac procedures(ICP) for treatment of acute myocardial infarction(AMI) have been well-documented. Whether these differences have diminished over time is unknown. A total of 291,009 patients(pts) admitted to coronary bypass surgery(CABG) capable hospitals with AMI in Pennsylvania from January 1995 to December 2006 were studied. Clinical, insurance and hospital characteristic data submitted to the Pennsylvania Health Care Cost Containment Council were analyzed by multiple logistic regression analysis, with interaction terms used between time periods of hospital discharges and ethnicity or poverty level to determine if disparities in the in-hospital use of ICP (cardiac catheterization, PCI and CABG) for AMI pts changed over time periods 1995–97, 1998 –2000, 2001– 03 and 2004 – 06. Younger age, male gender, smoking, uncomplicated hypertension, angina, hyperlipidemia, prior PCI, commercial insurance and higher hospital ICP volume were positively associated with and heart failure(CHF), diabetes, chronic pulmonary disease (COPD), complicated hypertension, chronic renal failure, prior stroke, MI or CABG and higher Mediqual Atlas™ severity score were negatively associated with undergoing ICP(all p<.0001). After adjustment for these variables, African-Americans were less likely to undergo an ICP for each time period (p<.0001; Table 1⇓), but the gap narrowed from 59% to 38% over time. The disparity in ICP in the poorest quintile vs. others (from percent of residents living in a pt’s zip code with household income below the federal poverty threshold) was strongly associated with not undergoing ICP in 1995–1997, but was not consistently significant thereafter. In a large statewide database of AMI pts, gaps in the use of ICP between lower and higher income pts and between whites and African-Americans narrowed from 1995 to 2006, but disparities persisted.