Abstract 21615: Disparities in Access to Revascularization After Acute Myocardial Infarction (MI) Before and After the 2002 IOM Report
The Institute of Medicine (IOM) report published in 2002 showed that Blacks were less likely to receive coronary revascularization such as CABG and stents even after controlling for insurance, income and age. It recommended that increased awareness of disparities among health professionals is needed to reduce this.We hypothesized that increased awareness of ethnic disparities since this report would have translated to reduction in disparities in coronary revascularization.
Methods: A retrospective analysis was conducted using data from the AHRQ's National Inpatient Sample (NIS) 1998–2007(10 years). All patients with acute myocardial infarction during this period were identified. The proportion that received percutaneous intervention (PCI) during the incident admission was compared in different ethnicities over the time period. Multivariate regression for each year was conducted using Poisson regression with robust variances to account for the relatively high rates of revascularizations. The analysis controlled for gender, insurance status, co-morbidities and hospital characteristics.
Results: Based on the database, about 2.04 million patients were managed for acute MI from 1998–2007. The primary revascularization rate during the incident admission among Whites was 23%, Blacks−17.6% and Hispanics−21.4% [P<0.001 (Reference group — White)]. On multivariate regression, females were less likely to receive PCI. In 2001 (just before the report), Blacks and Hispanics were 27%(p<0.001) and 12%(p<0.001) respectively, less likely to receive primary PCI compared to Whites. From 2003 to 2007, Blacks and Hispanics were on the average 33%(p<0.001) and 19%(p<0.001) less likely to receive primary PCI for acute MI compared to whites.
Conclusions: Ethnic disparities in coronary revascularization persist despite the 2002 IOM report. More definitive measures need to be effected to reduce these disparities.
- © 2010 by American Heart Association, Inc.