Race and sex differences in rates of invasive cardiac procedures in US hospitals. Data from the National Hospital Discharge Survey.
ABSTRACT Lower rates of invasive cardiac procedures have been reported for blacks and women than for white men. However, few studies have adjusted for differences in the type of hospital of admission, insurance status, and disease severity. SETTING, DESIGN, AND PARTICIPANTS: Data from the National Hospital Discharge Survey were used to investigate race and sex differences in rates of cardiac catheterization, percutaneous transluminal coronary angioplasty, and coronary artery bypass surgery among 10,348 persons hospitalized for acute myocardial infarction.
White men consistently had the highest procedure rates, followed by white women, black men, and black women. After matching for the hospital of admission and adjusting for age, in-hospital mortality, health insurance, and hospital transfer rates (with white men as the referent), the odds ratios for cardiac catheterization were 0.67 (95% confidence interval [CI], 0.51 to 0.87) for black men, 0.72 (95% CI, 0.63 to 0.83) for white women, and 0.50 (95% CI, 0.37 to 0.68) for black women. Similar race-sex differences were noted for percutaneous transluminal coronary angioplasty and coronary artery bypass surgery.
Race and sex differentials in the rates of invasive cardiac procedures remained despite matching for the hospital of admission and controlling for other factors that influence procedure rates, suggesting that the race and sex of the patient influence the use of these procedures.
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ABSTRACT: Among individuals with ischemic heart disease, young women with an acute myocardial infarction (AMI) represent an extreme phenotype associated with an excess mortality risk. Although women younger than 55 years of age account for less than 5% of hospitalized AMI events, almost 16 000 deaths are reported annually in this group, making heart disease a leading killer of young women. Despite a higher risk of mortality compared with similarly aged men, young women have been the subject of few studies. Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) is a large, observational study of the presentation, treatment, and outcomes of young women and men with AMI. VIRGO will enroll 2000 women, 18 to 55 years of age, with AMI and a comparison cohort of 1000 men with AMI from more than 100 participating hospitals. The aims of the study are to determine sex differences in the distribution and prognostic importance of biological, demographic, clinical, and psychosocial risk factors; to determine whether there are sex differences in the quality of care received by young AMI patients; and to determine how these factors contribute to sex differences in outcomes (including mortality, hospitalization, and health status). Blood serum and DNA for consenting participants will be stored for future studies. VIRGO will seek to identify novel and prognostic factors that contribute to outcomes in this young AMI population. Results from the study will be used to develop clinically useful risk-stratification models for young AMI patients, explain sex differences in outcomes, and identify targets for intervention.Circulation Cardiovascular Quality and Outcomes 11/2010; 3(6):684-93. · 5.66 Impact Factor
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ABSTRACT: This article examines attention-deficit/hyperactivity disorder (ADHD) in African American youth. Tackling the myths and misinformation surrounding ADHD in the African American community can be one of the most difficult issues in mental illness circles. There is a lot of conflicting information about how African Americans are diagnosed, examined, and treated. This article clarifies some of the misconceptions and offers some comprehensibility to the issue of ADHD in African American youth. The incidence of ADHD is probably similar in African Americans and Caucasians. However, fewer African Americans are diagnosed with and treated for ADHD. That reality flies in the face of some perceptions in many African American communities. Reasons for this disparity have not been fully clarified and are most likely complex and numerous. Some barriers to treatment are driven by the beliefs of patients and their families, while others are the result of limitations in the health care system. Patient-driven obstacles to care include inadequate knowledge of symptoms, treatment, and consequences of untreated ADHD and fear of overdiagnosis and misdiagnosis. System-driven limitations include a lack of culturally competent health care providers, stereotyping or biases, and failure of clinicians to evaluate the child in multiple settings before diagnosis.Current Psychiatry Reports 10/2010; 12(5):396-402. · 3.23 Impact Factor
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ABSTRACT: Disparities in the management of coronary artery disease were consistently documented in blacks and women in the 1980s and 1990s. Our objective was to determine if racial/ethnic and sex differences in the use of coronary revascularization persist in a more recent cohort. We examined all 20,604 Medicare beneficiaries admitted for acute coronary syndrome in 2001 from a random sample of 750,000 enrollees that was oversampled for black and Hispanic subjects to assess any cardiac revascularization. After controlling for demographics and comorbidities, black men and women (odds ratios [OR] 0.47, 0.40), Hispanic men and women (ORs 0.61, 0.52), and white women (OR 0.67) had lower rates of revascularization compared with white men. Lower revascularization rates persisted for white women (OR 0.67) and black men and women (OR 0.55 and 0.54), controlling for income status and geographic variation, but were no longer present in the Hispanic population. The mechanisms by which disparities operate may differ for Hispanic and black populations.Journal of Women s Health 02/2012; 21(2):126-32. · 1.42 Impact Factor