After adjusting for age, race, sex, and concurrent health problems
such as diabetes, the risk-adjusted 90-day mortality after AMI
was 20.1 percent in hospitals serving no African Americans and
23.7 percent in hospitals with the greatest share of black AMI
patients — a 19 percent higher rate. Heart attack patients treated
at largely minority-serving hospitals were not sicker and did not
have more severe heart attacks than patients at other hospitals,
the study showed. In fact, the data show that AMI patients treated
in hospitals with no African-American AMI patients were the sickest,
as measured by an index of comorbidities, but had the lowest risk-adjusted
The differences in risk-adjusted hospital mortality outcomes also
were not explained by patients’ income, type of hospital ownership,
the hospitals’ annual AMI patient volume, region of the country,
or urban status.
“We suspected that these differences could have been caused by
the higher rates of poverty among the elderly African-American
population, but this was not the case,” Skinner notes. Moreover,
he notes, the differences could not be attributed to the likelihood
of the hospital providing certain post-AMI surgical interventions,
such as coronary artery bypass grafting.
The researchers point out that in this study, 21 percent of the
hospitals treated 69 percent of the elderly African-American AMI
patients. The average Medicare AMI patient was treated in a hospital
where 6.9 percent of AMI patients were African American. Relative
to the hospital where the average AMI patient was treated, hospitals
that disproportionately treated African Americans were more likely
to be teaching facilities, more likely to be government-run (non-Federal),
and less likely to be not-for-profit.
The researchers further suggest that, because many African-American
Medicare beneficiaries live in urban areas with more than one hospital,
disparities might be reduced by directing patients toward hospitals
known to provide high-quality care.
To contact Dr. Richard Suzman: Call Susan Farrer or Vicky Cahan,
NIA Office of Communications and Public Liaison, 301-496-1752.
To contact Dr. Jonathan Skinner: Call Deborah Kimbell, Media Relations,
Dartmouth Medical School, 603-653-1913.
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