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Comparative Study
. 2005 Aug 18;353(7):671-82.
doi: 10.1056/NEJMsa032214.

Sex and racial differences in the management of acute myocardial infarction, 1994 through 2002

Viola Vaccarino  1 , Saif S Rathore, Nanette K Wenger, Paul D Frederick, Jerome L Abramson, Hal V Barron, Ajay Manhapra, Susmita Mallik, Harlan M Krumholz; National Registry of Myocardial Infarction Investigators
Affiliations
Comparative Study

Sex and racial differences in the management of acute myocardial infarction, 1994 through 2002

Viola Vaccarino et al. N Engl J Med. .

Abstract

Background: Although increased attention has been paid to sex and racial differences in the management of myocardial infarction, it is unknown whether these differences have narrowed over time.

Methods: With the use of data from the National Registry of Myocardial Infarction, we examined sex and racial differences in the treatment of patients who were deemed to be "ideal candidates" for particular treatments and in deaths among 598,911 patients hospitalized with myocardial infarction between 1994 and 2002.

Results: In the unadjusted analysis, sex and racial differences were observed for rates of reperfusion therapy (for white men, white women, black men, and black women: 86.5, 83.3, 80.4, and 77.8 percent, respectively; P<0.001), use of aspirin (84.4, 78.7, 83.7, and 78.4 percent, respectively; P<0.001), use of beta-blockers (66.6, 62.9, 67.8, and 64.5 percent; P<0.001), and coronary angiography (69.1, 55.9, 64.0, and 55.0 percent; P<0.001). After multivariable adjustment, racial and sex differences persisted for rates of reperfusion therapy (risk ratio for white women, black men, and black women: 0.97, 0.91, and 0.89, respectively, as compared with white men) and coronary angiography (relative risk, 0.91, 0.82, and 0.76) but were attenuated for the use of aspirin (risk ratio, 0.97, 0.98, and 0.94) and beta-blockers (risk ratio, 0.98, 1.00, and 0.96); all risks were unchanged over time. Adjusted in-hospital mortality was similar among white women (risk ratio, 1.05; 95 percent confidence interval, 1.03 to 1.07) and black men (risk ratio, 0.95; 95 percent confidence interval, 0.89 to 1.00), as compared with white men, but was higher among black women (risk ratio, 1.11; 95 percent confidence interval, 1.06 to 1.16) and was unchanged over time.

Conclusions: Rates of reperfusion therapy, coronary angiography, and in-hospital death after myocardial infarction, but not the use of aspirin and beta-blockers, vary according to race and sex, with no evidence that the differences have narrowed in recent years.

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Figures

Figure 1
Figure 1. Proportions of Patients Considered Ideally Suited for Treatments and Procedures after Acute Myocardial Infarction, According to Sex and Race by Study Year
A year was defined in this study as the period from June through May.
See this image and copyright information in PMC

Comment in

  • Health disparities--less talk, more action.
    Lurie N. Lurie N. N Engl J Med. 2005 Aug 18;353(7):727-9. doi: 10.1056/NEJMe058143. N Engl J Med. 2005. PMID: 16107626 No abstract available.
  • Trends in racial disparities in care.
    Kuller LH. Kuller LH. N Engl J Med. 2005 Nov 10;353(19):2081-5; author reply 2081-5. doi: 10.1056/NEJM200511103531918. N Engl J Med. 2005. PMID: 16282186 No abstract available.
  • Trends in racial disparities in care.
    Freedman BI, Wagenknecht LE, Bowden DW. Freedman BI, et al. N Engl J Med. 2005 Nov 10;353(19):2081-5; author reply 2081-5. N Engl J Med. 2005. PMID: 16285158 No abstract available.

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