Abstract P090: Non-Hospital Factors Exacerbate Racial Disparities in In-Hospital Outcomes Among Patients with Coronary Artery Disease
Background: Racial disparities in coronary artery disease (CAD) can worsen patient outcomes. While a number of studies have investigated racial disparities in CAD risk factors, the underlying mechanisms of racial disparities in the treatment outcomes in hospitalized CAD patients remain unclear.
Hypothesis: We hypothesized that racial disparities in in-hospital CAD mortality are, at least partially, attributed to non-hospital factors that are external to quality of in-hospital care.
Methods: We conducted a retrospective cohort study of in-hospital mortality in 9,128,116 hospitalized CAD patients (mean±SD age 72.4±13.0 years; 56.7% males) over a five-year time period. Multivariable logistic regression was used to obtain adjusted odds ratios (aOR) for in-hospital death in relation to patients’ race, adjusting for major clinical and demographic covariates.
Results: A total of 349,688 deaths occurred among 9,128,116 hospitalized CAD cases (3.8% mortality). Mortality in patients admitted through the emergency department was higher than in non-emergency admissions (4.3% vs. 2.8%, p<0.001). Deceased patients had more severe comorbidities than patients who were discharged alive: mean Elixhauser-Walraven comorbidity scores were 10.6±7.7 and 4.9±6.5, respectively (p<0.001), with higher scores indicating a more severe comorbidity status. African Americans were more likely to experience an emergency admittance than any other racial group, with 79.8% of African Americans admissions being through emergency department, compared to 70.9% of Asians admissions and 70.3% of Caucasians admissions (p<0.001, ANOVA with post-hoc analysis and correction for multiple comparisons). Asians had higher Elixhauser-Walraven scores (5.8±6.8) than African Americans (5.4±7.1) and Caucasians (5.0±6.5) (p<0.01). However, when adjusted for multiple confounders, African Americans were less likely to die than patients of other races (aOR = 0.91, 95% CI 0.90-0.92, p<0.001).
Conclusion: Racial disparities in in-hospital mortality for CAD patients do exist. These disparities are attributed to several factors, including the non-hospital factors external to quality of in-hospital care, such as lack of access to a high-quality primary care resulting in emergency admissions with more severe forms of CAD and severe comorbidities.
Author Disclosures: A.V. Sergeev: None.
- © 2017 by American Heart Association, Inc.