Abstract 17419: Sex and Race Related Disparities in Care and Outcomes After Hospitalization for Coronary Artery Disease Among Older Adults
Background: It is unclear to what extent following a standard performance protocol will help reduce gaps in cardiovascular health among sexes, racial/ethnic groups, and geographic regions in United States hospitals.
Method: Based on the Get With The Guidelines Coronary Artery Disease (GWTG-CAD) registry linked with Medicare inpatient data, we included 49,358 patients, age 65 years or older, from 366 US hospitals from 2003 to 2009. Our primary outcome was 3-year all-cause mortality. Exposures included sex, race/ethnicity, and geographic region. Our mediator was a composite score of quality of care, defined as the total number of performance measures the patient received divided by total number of performance measures the patient was eligible for. Logistic regression with generalized estimating equations and mediation analysis were used.
Results: During 3 years of follow-up, 16,130 deaths were identified. Compared with men, women were less likely to receive optimal care at discharge (adjusted odds ratio (aOR)=0.92, 95% Confidence Interval (CI): 0.88-0.95, p<0.0001). We identified a significant interaction between sex and quality of care measures (p for interaction=0.04). Compared with men, women had higher odds of mortality (aOR=1.23, 95%CI: 0.99-1.54, p=0.06) if they received sub-optimal care, though the sex disparity disappeared with optimal care (aOR=0.97, 95%CI: 0.92-1.01, p=0.13). There was no difference in terms of quality of care across racial/ethnic groups or geographic regions. Compared with whites, blacks had higher mortality (aOR=1.36, 95%CI: 1.24-1.50, p<0.0001), and the disparity persisted regardless of the quality of care received. We did not identify a significant mortality difference based on geographic region.
Conclusion: Compared with men, women were less likely to receive optimal care at discharge which was associated with higher mortality. The observed sex disparity in mortality could potentially be reduced or even eliminated by providing equitable and optimal care. In contrast, the higher mortality observed in black patients could not be accounted for by differences in the quality of care measured in this study. We did not observe differences in care or outcomes by geographic region.
Author Disclosures: S. Li: None. G.C. Fonarow: Consultant/Advisory Board; Modest; Medtronic, Amgen, Johnson & Johnson, Bayer, Boston Scientific. Research Grant; Significant; NIH. Consultant/Advisory Board; Significant; Novartis. K. Mukamal: None. L. Liang: None. P.J. Schulte: None. E.E. Smith: None. A. DeVore: None. A.F. Hernandez: None. E.D. Peterson: None. D.L. Bhatt: None.
- © 2015 by American Heart Association, Inc.