Race, sex, poverty, and the medical treatment of acute myocardial infarction in the elderly

Saif S. Rathore, Alan K. Berger, Kevin P. Weinfurt, Manning Feinleib, William J. Oetgen, Bernard J. Gersh, Kevin A. Schulman

Research output: Contribution to journalArticle

Abstract

Background - Race, sex, and poverty are associated with the use of diagnostic cardiac catheterization and coronary revascularization during treatment of acute myocardial infarction (AMI). However, the association of sociodemographic characteristics with the use of less costly, more readily available medical therapies remains poorly characterized. Methods and Results - We evaluated 169 079 Medicare beneficiaries ≥65 years of age treated for AMI between January 1994 and February 1996 to determine the association of patient race, sex, and poverty with the use of medical therapy. Multivariable regression models were constructed to evaluate the unadjusted and adjusted influence of sociodemographic characteristics on the use of 2 admission (aspirin, reperfusion) and 2 discharge therapies (aspirin, β-blockers) indicated during the treatment of AMI. Therapy use varied by patient race, sex, and poverty status. Black patients were less likely to undergo reperfusion (RR 0.84, 95% CI 0.78, 0.91) or receive aspirin on admission (RR 0.97, 95% CI 0.96, 0.99) and β-blockers (RR 0.94, 95% CI 0.88, 1.00) at discharge. Female patients were less likely to receive aspirin on admission (RR 0.98, 95% CI 0.97, 0.99) and discharge (RR 0.98, 95% CI 0.96, 0.99). Poor patients were less likely to receive aspirin (RR 0.97, 95% CI 0.96, 0.98) or reperfusion (RR 0.97, 95% CI 0.93, 1.00) on admission and aspirin (RR 0.98, 95% CI 0.96, 1.00), or β-blockers (RR 0.95, 95% CI 0.91, 0.99) on discharge. Conclusions - Medical therapies are currently underused in the treatment of black, female, and poor patients with AMI.

Original languageEnglish (US)
Pages (from-to)642-648
Number of pages7
JournalCirculation
Volume102
Issue number6
StatePublished - Aug 8 2000
Externally publishedYes

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Poverty
Myocardial Infarction
Aspirin
Reperfusion
Therapeutics
Cardiac Catheterization
Medicare

Keywords

  • Myocardial infarction
  • Outcomes
  • Race
  • Sex

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Rathore, S. S., Berger, A. K., Weinfurt, K. P., Feinleib, M., Oetgen, W. J., Gersh, B. J., & Schulman, K. A. (2000). Race, sex, poverty, and the medical treatment of acute myocardial infarction in the elderly. Circulation, 102(6), 642-648.

Race, sex, poverty, and the medical treatment of acute myocardial infarction in the elderly. / Rathore, Saif S.; Berger, Alan K.; Weinfurt, Kevin P.; Feinleib, Manning; Oetgen, William J.; Gersh, Bernard J.; Schulman, Kevin A.

In: Circulation, Vol. 102, No. 6, 08.08.2000, p. 642-648.

Research output: Contribution to journalArticle

Rathore, SS, Berger, AK, Weinfurt, KP, Feinleib, M, Oetgen, WJ, Gersh, BJ & Schulman, KA 2000, 'Race, sex, poverty, and the medical treatment of acute myocardial infarction in the elderly', Circulation, vol. 102, no. 6, pp. 642-648.
Rathore SS, Berger AK, Weinfurt KP, Feinleib M, Oetgen WJ, Gersh BJ et al. Race, sex, poverty, and the medical treatment of acute myocardial infarction in the elderly. Circulation. 2000 Aug 8;102(6):642-648.
Rathore, Saif S. ; Berger, Alan K. ; Weinfurt, Kevin P. ; Feinleib, Manning ; Oetgen, William J. ; Gersh, Bernard J. ; Schulman, Kevin A. / Race, sex, poverty, and the medical treatment of acute myocardial infarction in the elderly. In: Circulation. 2000 ; Vol. 102, No. 6. pp. 642-648.
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abstract = "Background - Race, sex, and poverty are associated with the use of diagnostic cardiac catheterization and coronary revascularization during treatment of acute myocardial infarction (AMI). However, the association of sociodemographic characteristics with the use of less costly, more readily available medical therapies remains poorly characterized. Methods and Results - We evaluated 169 079 Medicare beneficiaries ≥65 years of age treated for AMI between January 1994 and February 1996 to determine the association of patient race, sex, and poverty with the use of medical therapy. Multivariable regression models were constructed to evaluate the unadjusted and adjusted influence of sociodemographic characteristics on the use of 2 admission (aspirin, reperfusion) and 2 discharge therapies (aspirin, β-blockers) indicated during the treatment of AMI. Therapy use varied by patient race, sex, and poverty status. Black patients were less likely to undergo reperfusion (RR 0.84, 95{\%} CI 0.78, 0.91) or receive aspirin on admission (RR 0.97, 95{\%} CI 0.96, 0.99) and β-blockers (RR 0.94, 95{\%} CI 0.88, 1.00) at discharge. Female patients were less likely to receive aspirin on admission (RR 0.98, 95{\%} CI 0.97, 0.99) and discharge (RR 0.98, 95{\%} CI 0.96, 0.99). Poor patients were less likely to receive aspirin (RR 0.97, 95{\%} CI 0.96, 0.98) or reperfusion (RR 0.97, 95{\%} CI 0.93, 1.00) on admission and aspirin (RR 0.98, 95{\%} CI 0.96, 1.00), or β-blockers (RR 0.95, 95{\%} CI 0.91, 0.99) on discharge. Conclusions - Medical therapies are currently underused in the treatment of black, female, and poor patients with AMI.",
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AU - Rathore, Saif S.

AU - Berger, Alan K.

AU - Weinfurt, Kevin P.

AU - Feinleib, Manning

AU - Oetgen, William J.

AU - Gersh, Bernard J.

AU - Schulman, Kevin A.

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N2 - Background - Race, sex, and poverty are associated with the use of diagnostic cardiac catheterization and coronary revascularization during treatment of acute myocardial infarction (AMI). However, the association of sociodemographic characteristics with the use of less costly, more readily available medical therapies remains poorly characterized. Methods and Results - We evaluated 169 079 Medicare beneficiaries ≥65 years of age treated for AMI between January 1994 and February 1996 to determine the association of patient race, sex, and poverty with the use of medical therapy. Multivariable regression models were constructed to evaluate the unadjusted and adjusted influence of sociodemographic characteristics on the use of 2 admission (aspirin, reperfusion) and 2 discharge therapies (aspirin, β-blockers) indicated during the treatment of AMI. Therapy use varied by patient race, sex, and poverty status. Black patients were less likely to undergo reperfusion (RR 0.84, 95% CI 0.78, 0.91) or receive aspirin on admission (RR 0.97, 95% CI 0.96, 0.99) and β-blockers (RR 0.94, 95% CI 0.88, 1.00) at discharge. Female patients were less likely to receive aspirin on admission (RR 0.98, 95% CI 0.97, 0.99) and discharge (RR 0.98, 95% CI 0.96, 0.99). Poor patients were less likely to receive aspirin (RR 0.97, 95% CI 0.96, 0.98) or reperfusion (RR 0.97, 95% CI 0.93, 1.00) on admission and aspirin (RR 0.98, 95% CI 0.96, 1.00), or β-blockers (RR 0.95, 95% CI 0.91, 0.99) on discharge. Conclusions - Medical therapies are currently underused in the treatment of black, female, and poor patients with AMI.

AB - Background - Race, sex, and poverty are associated with the use of diagnostic cardiac catheterization and coronary revascularization during treatment of acute myocardial infarction (AMI). However, the association of sociodemographic characteristics with the use of less costly, more readily available medical therapies remains poorly characterized. Methods and Results - We evaluated 169 079 Medicare beneficiaries ≥65 years of age treated for AMI between January 1994 and February 1996 to determine the association of patient race, sex, and poverty with the use of medical therapy. Multivariable regression models were constructed to evaluate the unadjusted and adjusted influence of sociodemographic characteristics on the use of 2 admission (aspirin, reperfusion) and 2 discharge therapies (aspirin, β-blockers) indicated during the treatment of AMI. Therapy use varied by patient race, sex, and poverty status. Black patients were less likely to undergo reperfusion (RR 0.84, 95% CI 0.78, 0.91) or receive aspirin on admission (RR 0.97, 95% CI 0.96, 0.99) and β-blockers (RR 0.94, 95% CI 0.88, 1.00) at discharge. Female patients were less likely to receive aspirin on admission (RR 0.98, 95% CI 0.97, 0.99) and discharge (RR 0.98, 95% CI 0.96, 0.99). Poor patients were less likely to receive aspirin (RR 0.97, 95% CI 0.96, 0.98) or reperfusion (RR 0.97, 95% CI 0.93, 1.00) on admission and aspirin (RR 0.98, 95% CI 0.96, 1.00), or β-blockers (RR 0.95, 95% CI 0.91, 0.99) on discharge. Conclusions - Medical therapies are currently underused in the treatment of black, female, and poor patients with AMI.

KW - Myocardial infarction

KW - Outcomes

KW - Race

KW - Sex

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