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: Objectives: To determine sex bias in the selection of strategies to evaluate patients with acute myocardial infarction (AMI), and determine if the choice of strategy influences survival. Background: Controversy exists regarding the role of female sex in the use of invasive evaluation for AMI and its possible effect on adverse outcomes. Methods: Electronic health record data from the Geisinger Acute Myocardial Infarction Cohort (GAMIC) was analyzed which included 1,968 men and 1,047 women admitted to the Geisinger Medical Center between January 2001 and December 2006 with acute myocardial infarction (AMI).Multivariate logistic regression analyses were used to determine independent correlates of an invasive evaluation. Multivariate logistic regression modeling stratified on sex was used to determine when invasive evaluation was done and whether there was a correlation with mortality. Results: In unadjusted analyses, male sex was a significant predictor for the use of invasive evaluation (odds ratio = 1.71, 95% CI =[1.46, 2.00]). Adjusted for baseline differences (like age, renal function, co-morbid conditions) multivariate analyses found no significant relationship between male sex and invasive evaluation (OR = 1.02, 95% CI =[0.82, 1.23]). Females in the STEMI group were found to be less revascularized. No difference was observed in the one-year mortality between women and men regardless of invasive evaluation or revascularization. Conclusions: Sex was not independently associated with the occurrence of an invasive evaluation of a MI. Females in the STEMI group were less revascularized. There was no strong gender effect on survival irrespective of the performance on an invasive evaluation or revascularization. (J Interven Cardiol 2012;**:1-8).Journal of Interventional Cardiology 12/2012; · 1.50 Impact Factor
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ABSTRACT: AIM: Few studies have examined the effects of various interventions in gastroparesis. The goal of the present study was to determine whether inpatient management and outcomes differed among states across the United States. METHODS: Using population statistics and the State Inpatient Database (Agency for Healthcare Research and Quality), regional differences in admissions for gastroparesis, inpatient mortality, length of stay, nursing home transfers, and rates of endoscopy, gastrostomy placement, and nutritional support were assessed. RESULTS: Admissions for gastroparesis ranged from 24.3 ± 0.8/100,000 in Utah to 117.1 ± 9.7/100,000 in Maryland, with mortality rates similarly varying fourfold from 0.5 ± 0.1/100,000 in Colorado to 2.3 ± 0.1/100,000 in Florida. Intervention rates differed between states (endoscopy: 6.8 ± 0.8 % in Wyoming versus 23.1 ± 0.4 % in Florida; gastrostomy: 0.8 ± 0.1 % in North Carolina versus 3.3 ± 0.8 % in Hawaii; nutritional support: 1.2 ± 0.2 % in West Virginia versus 7.0 ± 0.6 % in New Jersey). Admissions rates were independently predicted by high overall hospitalizations within a state. Higher population density, median incomes and admissions to for-profit hospitals correlated with endoscopy rates. Coexisting heart failure and male gender were associated with higher likelihood of gastrostomy placement, while initiation of nutritional support was predicted by physician supply and insurance status. Age cohort, Medicare coverage, poverty rates and endoscopic testing independently predicted mortality, while length of stay correlated with diagnostic and therapeutic interventions. CONCLUSIONS: There is a significant variability in admissions, interventions and outcomes for gastroparesis. While biological factors, such as comorbidities and age, contribute to this variability, the data suggest that socioeconomic variables significantly affect approaches to gastroparesis treatment in the United States.Digestive Diseases and Sciences 03/2013; · 2.26 Impact Factor
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ABSTRACT: : Epidemiological studies have demonstrated racial disparities in the workup of emergency department patients with chest pain and the referral of admitted patients for intervention. However, little is known about possible disparities in stress test utilization in low-risk chest pain patients admitted to emergency department chest pain units. : A retrospective observational study of consecutive chest pain unit patients was conducted. Eligibility criteria included age >18 years, American Heart Association low-to-intermediate risk, nondynamic electrocardiograms, and normal initial troponin I. Patients aged >75 years with a history of coronary artery heart disease were excluded. On each patient, we calculated a Thrombolysis in Myocardial Infarction (TIMI) risk prediction score and a Diamond and Forrester (D&F) score for likelihood of coronary artery disease. Two separate multivariate analyses were completed, one including the TIMI score and the other including D&F score, using logistic regression to estimate odds ratios (ORs) for receiving testing based on race, controlling for other relevant covariates. : Two thousand four hundred fifty-one patients were enrolled over a planned 1.5-year period. In total, 59.7% [95% confidence interval (CI) 57.8-61.7] of patients were white, 11.6% (95% CI 10.4-12.9) African American, and 28.6% (95% CI 26.9-30.4) "other." The overall stress testing rate was 50.3% (95% CI 48.4-52.3). After controlling for insurance and TIMI or D&F scores, African American patients had significantly decreased odds of stress testing (ORTIMI 0.68, 95% CI 0.52-0.89; ORD&F 0.67, 95% CI 0.51-0.89). : Our study confirms racial disparities in the utilization of stress testing in the chest pain unit. Further investigation is needed to identify specific provider or patient-level factors that may contribute to this disparity.Critical pathways in cardiology 03/2013; 12(1):9-13.