Racial disparities among older adults with acute myocardial infarction: The SILVER-AMI study

Abstract

Background: Despite an aging population, little is known about racial disparities in aging-specific functional impairments and mortality among older adults hospitalized for acute myocardial infarction (AMI).

Methods: We analyzed data from patients aged 75 years or older who were hospitalized for AMI at 94 US hospitals from 2013 to 2016. Functional impairments and geriatric conditions were assessed in-person during the AMI hospitalization. The association between race and risk of mortality (primary outcome) was evaluated with logistic regression adjusted sequentially for age, clinical characteristics, and measures of functional impairment and other conditions associated with aging.

Results: Among 2918 participants, 2668 (91.4%) self-identified as White and 250 (8.6%) as Black. Black participants were younger (80.8 vs 81.7 years; p = 0.010) and more likely to be female (64.8% vs 42.5%; p < 0.001). Black participants were more likely to present with impairments in cognition (37.6% vs 14.5%; p < 0.001), mobility (66.0% vs 54.6%; p < 0.001) and vision (50.1% vs 35.7%; p < 0.001). Black participants were also more likely to report a disability in one or more activities of daily living (22.4% vs 13.0%; p < 0.001) and an unintentional loss of more than 10 lbs in the year prior to hospitalization (37.2% vs 13.0%; p < 0.001). The unadjusted odds of 6-month mortality among Black participants (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.4-2.8) attenuated to non-significance after adjustment for age, clinical characteristics (OR 1.70, 95% CI 1.7, 1.2-2.5), and functional/geriatric conditions (OR 1.5, 95% CI 1.0-2.2).

Conclusions: Black participants had a more geriatric phenotype despite a younger average age, with more functional impairments. Controlling for functional impairments and geriatric conditions attenuated disparities in 6-month mortality somewhat. These findings highlight the importance of systematically assessing functional impairment during hospitalization and also ensuring equitable access to community programs to support post-AMI recovery among Black older adults.

Keywords: Black/African American; acute myocardial infarction; functional impairment; health care disparities; race.

Figure 1:. Functional impairments and geriatric conditions: Black versus White participants at hospitalization.

Mobility impairment defined as a Timed Get Up and Go (TUG) test time of > 15 seconds. Muscle strength impairment was defined as < 18.5 kg for women and < 28.5 kg for men on best of 3 handheld dynamometer measurements. Cognitive impairment defined as Telephone Interview of Cognitive Status (TICS) score of < 27. Hearing and vision impairment were self-reported. ADL, activity of daily living (bathing, dressing, getting out of a chair, and ambulating) 1 month prior to admission. Data missing for < 5% of participants for all variables except mobility impairment (19.6% of Black participants and 15.2% of White participants). P<0.001 (***).

Figure 2.. Sequentially adjusted odds ratios of 6-month mortality: Black versus White participants.

We generated four logistic regression models of race versus 6-month mortality, sequentially adding age, clinical characteristics (length of stay, history of sleep apnea, history of peripheral arterial disease, hemoglobin, heart rate, glomerular filtration rate, ejection fraction and revascularization status), and functional impairments and other geriatric conditions (mobility impairment, hearing impairment, SF-12 score, and unintentional weight loss of 10 or more pounds in the past year).