Trends in and disparities for acute myocardial infarction: an analysis of Medicare claims data from 1992 to 2010

BMC Medicine

Peter Cram¹  Said Ibrahim⁴  Xin Lu³  Jasvinder A Singh² 

[1] Faculty of Medicine, University of Toronto, Toronto, ON, Canada;Medicine Service, Birmingham Veterans Affairs Medical Center, the University of Alabama at Birmingham, 510 S 20th Street, Faculty Office Tower 805B, Birmingham 35294, AL, UK;Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine and CADRE, Iowa City Veterans Administration Medical Center, 451 Newton Road 200 Medicine Administration Building, Iowa City 52242, IA, USA;Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, the Perelman University of Pennsylvania School of Medicine, 3400 Spruce St, Philadelphia 19104, PA, USA

关键词: Hospitalization rates;    PCI;    Mortality;    Sex;    Race;    Outcomes;    Disparity;    MI;    Myocardial infarction;   

Others  :  1118373
DOI  :  10.1186/s12916-014-0190-6

 received in 2014-06-21, accepted in 2014-09-22,  发布年份 2014

【 摘 要 】

Background

It is unknown whether previously reported disparities for acute myocardial infarction (AMI) by race and sex have declined over time.

Methods

We used Medicare Part A administrative data files for 1992 to 2010 to evaluate changes in per-capita hospitalization rates for AMI, rates of revascularization (percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG)), and 30-day mortality for four distinct patient subcohorts: black women; black men; white women; and white men, adjusted for age, comorbidities and year using logistic regression.

Results

The study sample consisted of 4,045,267 AMI admissions between the years 1992 and 2010 (166,660 black women; 116,201 black men; 1,870,816 white women; 1,891,590 white men). AMI hospitalization rates differed significantly in 1992 to 1993 among black women (61.6 hospitalizations per 10,000 Medicare enrollees), black men (73.2 hospitalizations), white women (72.0 hospitalizations) and white men (113.2 hospitalizations) (P <0.0001). By 2009 to 2010 AMI hospitalization rates had declined substantially in all cohorts but disparities remained with significantly lower hospitalization rates among women and blacks compared to men and whites, respectively (P <0.0001). In multivariable-adjusted analyses, despite narrowing of the differences between cohorts over time, disparities in AMI hospitalization rates by race and sex remained statistically significant in 2009 to 2010 (P <0.001). In 1992 to 1993 and 2009 to 2010, rates of PCI within 30-days of AMI differed significantly among black women (8.6% in 1992 to 1993; 24.2% in 2009 to 2010), black men (10.4% and 32.6%), white women (12.8% and 30.5%), and white men (16.1% and 40.7%) (P <0.0001). In multivariable-adjusted analyses, racial disparities in procedure utilization appeared somewhat larger and sex-based disparities remained significant. Unadjusted 30-day mortality after AMI in 1992 to 1993 for black women, black men, white women and white men was 20.4%, 17.9%, 23.1% and 19.5%, respectively (P <0.0001); in 2009 to 2010 mortality was 17.1%, 15.3%, 18.2% and 16.2%, respectively (P <0.0001). In adjusted analyses, racial differences in mortality declined over time but differences by sex (higher mortality for women) persisted.

Conclusions

Disparities in AMI have declined modestly, but remain a problem, particularly with respect to patient sex.

【 授权许可】

   
2014 Singh et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Ani C, Pan D, Martins D, Ovbiagele B: Age- and sex-specific in-hospital mortality after myocardial infarction in routine clinical practice. Cardiol Res Pract 2010, 2010:752765.
• [2]Barnato AE, Lucas FL, Staiger D, Wennberg DE, Chandra A: Hospital-level racial disparities in acute myocardial infarction treatment and outcomes. Med Care 2005, 43:308-319.
• [3]Bertoni AG, Goonan KL, Bonds DE, Whitt MC, Goff DC Jr, Brancati FL: Racial and ethnic disparities in cardiac catheterization for acute myocardial infarction in the United States, 1995–2001. J Natl Med Assoc 2005, 97:317-323.
• [4]Bradley EH, Herrin J, Wang Y, McNamara RL, Webster TR, Magid DJ, Blaney M, Peterson ED, Canto JG, Pollack CV Jr, Krumholz HM: Racial and ethnic differences in time to acute reperfusion therapy for patients hospitalized with myocardial infarction. JAMA 2004, 292:1563-1572.
• [5]Bullen C, Beaglehole R: Ethnic differences in coronary heart disease case fatality rates in Auckland. Aust N Z J Public Health 1997, 21:688-693.
• [6][http:/ / www.iom.edu/ ~/ media/ Files/ Report%20Files/ 2009/ ComparativeEffectivenessResearchPri orities/ Stand%20Alone%20List%20of%20100%20C ER%20Priorities%20-%20for%20web.ash x] webcite Institute of Medicine. 100 Initial Priority Topics for Comparative Effectiveness Research. National Academies Press; 2009. .
• [7][http://ec.europa.eu/health/health_structural_funds/policy/index_en.htm] webcite European Commission. Public Health. The EU cohesion policy and health []
• [8][http://www.who.int/sdhconference/background/news/facts/en/] webcite World Conference on Social Determinants of Health []
• [9]Cartwright-Smith L, Rosenbaum S, Mehta D: Disparities Reduction and Minority Health Improvement under the ACA. The George Washington University School of Public Health and Health Services, Volume 3. Washington, D.C; 2011.
• [10]Jha AK, Fisher ES, Li Z, Orav EJ, Epstein AM: Racial trends in the use of major procedures among the elderly. N Engl J Med 2005, 353:683-691.
• [11]Escarce JJ, McGuire TG: Methods for using Medicare data to compare procedure rates among Asians, blacks, Hispanics, Native Americans, and whites. Health Serv Res 2003, 38:1303-1317.
• [12]Guadagnoli E, Landrum MB, Peterson EA, Gahart MT, Ryan TJ, McNeil BJ: Appropriateness of coronary angiography after myocardial infarction among Medicare beneficiaries. Managed care versus fee for service. N Engl J Med 2000, 343:1460-1466.
• [13]Peterson ED, Shaw LK, DeLong ER, Pryor DB, Califf RM, Mark DB: Racial variation in the use of coronary-revascularization procedures. Are the differences real? Do they matter? N Engl J Med 1997, 336:480-486.
• [14]Vaughan-Sarrazin MS, Hannan EL, Gormley CJ, Rosenthal GE: Mortality in Medicare beneficiaries following coronary artery bypass graft surgery in states with and without certificate of need regulation. JAMA 2002, 288:1859-1866.
• [15]Elixhauser A, Steiner C, Harris DR, Coffey RM: Comorbidity measures for use with administrative data. Med Care 1998, 36:8-27.
• [16][http:/ / www.henlearner.org/ wp-content/ uploads/ 2012/ 03/ Hospital-Readmissions_Metric-Mainte nance-Technical-Report.pdf] webcite Centers for Medicare and Medicaid Services: 2012 measures maintenance technical report: acute myocardial infarction, heart failure, and pneumonia 30-day risk-standardized mortality measures.
• [17]Hardoon SL, Whincup PH, Petersen I, Capewell S, Morris RW: Trends in longer-term survival following an acute myocardial infarction and prescribing of evidenced-based medications in primary care in the UK from 1991: a longitudinal population-based study. J Epidemiol Community Health 2011, 65:770-774.
• [18]Peterson ED, Shah BR, Parsons L, Pollack CV Jr, French WJ, Canto JG, Gibson CM, Rogers WJ: Trends in quality of care for patients with acute myocardial infarction in the National Registry of Myocardial Infarction from 1990 to 2006. Am Heart J 2008, 156:1045-1055.
• [19]Werner RM, Goldman LE, Dudley RA: Comparison of change in quality of care between safety-net and non-safety-net hospitals. JAMA 2008, 299:2180-2187.
• [20]Chen J, Normand SL, Wang Y, Drye EE, Schreiner GC, Krumholz HM: Recent declines in hospitalizations for acute myocardial infarction for Medicare fee-for-service beneficiaries: progress and continuing challenges. Circulation 2010, 121:1322-1328.
• [21]Talbott EO, Rager JR, Brink LL, Benson SM, Bilonick RA, Wu WC, Han YY: Trends in acute myocardial infarction hospitalization rates for US States in the CDC tracking network. PLoS One 2013, 8:e64457.
• [22]Fang J, Alderman MH: Dissociation of hospitalization and mortality trends for myocardial infarction in the United States from 1988 to 1997. Am J Med 2002, 113:208-214.
• [23]Salomaa V, Koukkunen H, Ketonen M, Immonen-Raiha P, Karja-Koskenkari P, Mustonen J, Lehto S, Torppa J, Lehtonen A, Tuomilehto J, Kesäniemi YA, Pyörälä K: A new definition for myocardial infarction: what difference does it make? Eur Heart J 2005, 26:1719-1725.
• [24]Schmidt M, Jacobsen JB, Lash TL, Botker HE, Sorensen HT: 25 year trends in first time hospitalisation for acute myocardial infarction, subsequent short and long term mortality, and the prognostic impact of sex and comorbidity: a Danish nationwide cohort study. BMJ 2012, 344:e356.
• [25]Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER 3rd, et al.: Heart disease and stroke statistics–2013 update: a report from the American Heart Association. Circulation 2013, 127:e6-e245.
• [26]Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER 3rd, Moy CS, et al.: Heart disease and stroke statistics–2014 update: a report from the American Heart Association. Circulation 2014, 129:e28-e292.
• [27]Popescu I, Vaughan-Sarrazin MS, Rosenthal GE: Differences in mortality and use of revascularization in black and white patients with acute MI admitted to hospitals with and without revascularization services. JAMA 2007, 297:2489-2495.
• [28]Brown CP, Ross L, Lopez I, Thornton A, Kiros GE: Disparities in the receipt of cardiac revascularization procedures between blacks and whites: an analysis of secular trends. Ethn Dis 2008, 18:S2-S112-S117.
• [29]Maynard C, Litwin PE, Martin JS, Cerqueira M, Kudenchuk PJ, Ho MT, Kennedy JW, Cobb LA, Schaeffer SM, Hallstrom AP, Weaver WD: Characteristics of black patients admitted to coronary care units in metropolitan Seattle: results from the Myocardial Infarction Triage and Intervention Registry (MITI). Am J Cardiol 1991, 67:18-23.
• [30]Mukamel DB, Weimer DL, Mushlin AI: Referrals to high-quality cardiac surgeons: patients’ race and characteristics of their physicians. Health Serv Res 2006, 41:1276-1295.
• [31]Vaccarino V, Rathore SS, Wenger NK, Frederick PD, Abramson JL, Barron HV, Manhapra A, Mallik S, Krumholz HM: Sex and racial differences in the management of acute myocardial infarction, 1994 through 2002. N Engl J Med 2005, 353:671-682.
• [32]Vaccarino V, Parsons L, Every NR, Barron HV, Krumholz HM: Sex-based differences in early mortality after myocardial infarction. National Registry of Myocardial Infarction 2 Participants. N Engl J Med 1999, 341:217-225.
• [33]Iribarren C, Tolstykh I, Somkin CP, Ackerson LM, Brown TT, Scheffler R, Syme L, Kawachi I: Sex and racial/ethnic disparities in outcomes after acute myocardial infarction: a cohort study among members of a large integrated health care delivery system in northern California. Arch Intern Med 2005, 165:2105-2113.
• [34]Lehto HR, Lehto S, Havulinna AS, Ketonen M, Lehtonen A, Kesaniemi YA, Airaksinen KJ, Salomaa V: Sex differences in short- and long-term case-fatality of myocardial infarction. Eur J Epidemiol 2011, 26:851-861.
• [35]Vaidya D, Becker DM, Bittner V, Mathias RA, Ouyang P: Ageing, menopause, and ischaemic heart disease mortality in England, Wales, and the United States: modelling study of national mortality data. BMJ 2011, 343:d5170.
• [36]Nauta ST, Deckers JW, van Domburg RT, Akkerhuis KM: Sex-related trends in mortality in hospitalized men and women after myocardial infarction between 1985 and 2008: equal benefit for women and men. Circulation 2012, 126:2184-2189.