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Variation in Seeking Care for Cardiovascular Disease and Ambulance Utilization among Migrants in Australia: Time, Ethnicity, and Delay (TED) Study III. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031516. [PMID: 35162538 PMCID: PMC8834978 DOI: 10.3390/ijerph19031516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 02/04/2023]
Abstract
Insight into differences in seeking medical care for chest pain among migrant populations is limited. This study aimed to determine ethnic differences in seeking care behaviors and using ambulances among migrants compared to an Australian-born group. A total of 607 patients presenting with chest pain to a tertiary hospital between 1 July 2012 and 30 June 2014 were randomly selected. Data from the emergency department dataset and medical record reviews were collected and linked for analysis. The migrant group was stratified into nine ethnic groups for analysis based on the Australian Standard Classification of Cultural and Ethnic Groups. The overall median prehospital delay time was 3.7 (1.5, 10.7) h, which ranged from 2.5 (1.0, 10.7) (Southern and Eastern European group) to 6.0 (2.3, 20.6) (Sub-Saharan African group). The median decision time was 2.0 (0.8, 7.9) h, which ranged from 1.5 (Australian-born group) to 4.5 h (Sub-Saharan African group). Five ethnic groups had significantly longer decision times compared to the Australian-born group. Decision time accounted for 58.4% of pre-hospital delay time. Migrant patients were 60% less likely to seek care for chest pain within one hour (odds ratio 0.40, (0.23–0.68), p = 0.001). There was no significant difference in ambulance utilization between migrant and Australian-born groups. In conclusion, ethnic differences in seeking care for chest pain do exist, and ethnicity plays a vital role in a longer delay in seeking care. To reduce the delays and improve patient outcomes, appropriate health campaigns focusing on ethnic differences among migrant populations and normalizing cultural competency into practice are recommended.
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Rostomian AH, Soverow J, Sanchez DR. Exploring Armenian Ethnicity as an Independent Risk Factor for Cardiovascular Disease: Findings from a Prospective Cohort of Patients in a County Hospital. JRSM Cardiovasc Dis 2020; 9:2048004020956853. [PMID: 32983420 PMCID: PMC7498958 DOI: 10.1177/2048004020956853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/29/2020] [Accepted: 08/14/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES While several studies have examined the risk of cardiovascular disease (CVD) in larger racial and ethnic groups within the United States, limited information is available on smaller sub-populations, such as Armenians, with high rates of CVD in their home country. This study examined the association between Armenian ethnicity and a positive exercise treadmill test (ETT). DESIGN Prospective cohort study of patients at a 377-bed county hospital in Los Angeles, California from 2008-2011. SETTING All patients were interviewed at the time of ETT to assess their cardiovascular risk factors at the cardiac laboratory of the hospital. PARTICIPANTS 5,006 patients between 18-89 years of age, of whom 12.6% were of Armenian ethnicity and 54.4% were female.Main Outcome Measure: ETT results as a proxy for CVD risk. RESULTS After adjusting for cardiovascular risk factors, Armenian ethnicity was significantly associated with higher odds of positive ETT (OR = 1.40, p = 0.01). Known coronary artery disease CAD (OR = 2.28, p < 0.01), hyperlipidemia (OR = 1.37, p < 0.01), and hypertension (OR = 1.24, p = 0.05) were significantly associated with higher odds of a positive ETT. In subgroup analyses, hyperlipidemia was the only significant predictor of positive ETT (OR = 1.92, p = 0.02) among Armenians, while patient history of CAD (OR = 2.49, p < 0.01), hyperlipidemia (OR = 1.29, p = 0.03), and age (OR = 1.04, p < 0.01) were significant predictors among non-Armenians. Armenian ethnicity remained associated with higher odds of positive ETT (OR = 1.40, p < 0.01) when patients with CAD were excluded. CONCLUSION Armenian ethnicity may be an independent risk factor for CVD, influenced by the uniformity of the genetic pool and cultural and dietary exposures.
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Affiliation(s)
- Ara H Rostomian
- Division of Cardiology, Olive View-UCLA Medical Center, Sylmar,
CA, USA
- Kaiser Permanente, Los Angeles Medical Center, Los Angeles, CA,
USA
| | - Jonathan Soverow
- Division of Cardiology, Olive View-UCLA Medical Center, Sylmar,
CA, USA
| | - Daniel R Sanchez
- Division of Cardiology, Olive View-UCLA Medical Center, Sylmar,
CA, USA
- Kaiser Permanente, Los Angeles Medical Center, Los Angeles, CA,
USA
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Taylor HA, Henderson F, Abbasi A, Clifford G. Cardiovascular Disease in African Americans: Innovative Community Engagement for Research Recruitment and Impact. Am J Kidney Dis 2019; 72:S43-S46. [PMID: 30343723 DOI: 10.1053/j.ajkd.2018.06.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/25/2018] [Indexed: 12/22/2022]
Abstract
Historical events and the illumination of unequal treatment of cardiovascular and other diseases among African Americans and their white counterparts have suppressed African Americans' participation in research. Approaches that bring scientific professionals into actual partnership with affected communities show promise for overcoming this reluctance. Two examples are the Jackson Heart Study (JHS) and the emerging Moyo Health Network (MOYO). JHS uses layers of community engagement, including a pioneering effort to develop future health scientists and practitioners, the JHS Undergraduate Training and Education Center (UTEC). JHS-UTEC focuses on preparing young adults and teenagers (mostly African Americans) for rigorous higher-level learning and careers in health research and practice. MOYO is a mobile platform for health research to examine factors contributing to the development of disparities in the young while creating channels to disseminate interventions. Community trust in MOYO is substantially enhanced through its education and training program, which offers engaging ideation events along with app development and coding training opportunities to young people. Participants impart their cultural insights while using newly acquired technology skills to help with the community-focused design and launch of the network. The JHS and MOYO provide models for addressing cardiovascular health disparities by fostering community partnerships.
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Affiliation(s)
- Herman A Taylor
- Morehouse School of Medicine, Cardiovascular Research Institute, Atlanta, GA.
| | | | - Ahmed Abbasi
- McIntire School of Commerce, University of Virginia, Charlottesville, VA
| | - Gari Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Center for Health & Humanitarian Systems (CHHS), Georgia Institute of Technology, Atlanta, GA
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Anderson E, Glogoza M, Bettenhausen A, Guenther R, Dangerfield D, Jansen R, Newman R, Warne D, Dyke C. Disparities in Cardiovascular Risk Factors in Northern Plains American Indians Undergoing Coronary Artery Bypass Grafting. Health Equity 2018; 2:152-160. [PMID: 30283862 PMCID: PMC6110186 DOI: 10.1089/heq.2018.0021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: Heart disease is the leading cause of death in American Indians (AIs). For AI patients with severe coronary artery disease requiring coronary artery bypass graft (CABG) surgery, little data exist. The purpose of this study was to evaluate short-term outcomes of Northern Plains AI undergoing CABG and identify variations in patient presentation. Methods: All patients undergoing isolated CABG between June 2012 and June 2017 were studied. Seventy-four AI and 1236 non-American Indian (non-AI) patients were identified. Risk factors, preoperative characteristics, cardiac status, procedural information, and outcomes were collected. Univariate analysis comparing short-term clinical outcomes between AI and non-AI populations was performed. Multivariable logistic regression models were constructed and outcome differences assessed. Unadjusted Kaplan-Meier survival estimates were produced using 5-year survival data. Results: AI patients presented with increased risk factors, including higher rates of diabetes mellitus (AI 63.5% vs. non-AI 38.7% p=< 0.001) and smoking/tobacco use (AI 60.8% vs. non-AI 20.0% p=> 0.001). Seventy-nine percent of AI patients resided on or near federal reservations and presented from rural locations. Internal mammary artery (IMA) graft use in both groups was high (AI 95.9% vs. non-AI 94.9% p=0.904), and multiarterial grafting with left internal mammary artery and radial artery use was common in both groups (AI 67.6% vs. non-AI 69.6% p=0.814). No significant differences in unadjusted 30-day mortality or short-term outcomes were detected. Adjusted Kaplan-Meier survival curves were similar between race groups up through 5 years after CABG (p-value=0.38). Conclusion: AIs presented with significantly more risk factors for cardiovascular disease compared with the general population, with especially high rates of insulin-dependent diabetes and active tobacco use. Despite this, outcomes were similar between groups. In propensity-matched groups, AIs were at decreased risk for prolonged length of stay and combined morbidity/mortality. In contrast to previous reports, AI racial identity did not adversely affect survival up to 5 years after CABG.
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Affiliation(s)
- Eric Anderson
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| | - Matthew Glogoza
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| | - Aaron Bettenhausen
- Department of Cardiothoracic Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Rory Guenther
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| | - Dylan Dangerfield
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| | - Rick Jansen
- Department of Public Health, North Dakota State University, Fargo, North Dakota
| | - Roxanne Newman
- Department of Cardiothoracic Surgery, Sanford Health Fargo, Fargo, North Dakota
| | - Donald Warne
- Department of Public Health, North Dakota State University, Fargo, North Dakota
| | - Cornelius Dyke
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
- Department of Cardiothoracic Surgery, Sanford Health Fargo, Fargo, North Dakota
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Wechkunanukul K, Grantham H, Damarell R, Clark RA. The association between ethnicity and delay in seeking medical care for chest pain: a systematic review. ACTA ACUST UNITED AC 2018; 14:208-35. [PMID: 27532797 DOI: 10.11124/jbisrir-2016-003012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Acute coronary syndrome (ACS) is a leading cause of mortality and morbidity worldwide, and chest pain is one of the most common symptoms of ACSs. A rapid response to chest pain by patients and appropriate management by health professionals are vital to improve survival rates.People from different ethnic groups are likely to have different perceptions of chest pain, its severity and the need for urgent treatment. These differences in perception may contribute to differences in response to chests pain and precipitate unique coping strategies. Delay in seeking medical care for chest pain in the general population has been well documented; however, limited studies have focused on delay times within ethnic groups. There is little research to date as to whether ethnicity is associated with the time taken to seek medical care for chest pain. Consequently, addressing this gap in knowledge will play a crucial role in improving the health outcomes of culturally and linguistically diverse (CALD) patients suffering from chest pain and for developing appropriate clinical practice and public awareness for these populations. OBJECTIVES The current review aimed to determine if there is an association between ethnicity and delay in seeking medical care for chest pain among CALD populations. INCLUSION CRITERIA TYPES OF PARTICIPANTS Patients from different ethnic minority groups presenting to emergency departments (EDs) with chest pain. TYPES OF EXPOSURE The current review will examine studies that evaluate the association between ethnicity and delay in seeking medical care for chest pain among CALD populations. TYPES OF STUDIES The current review will consider quantitative studies including randomized controlled trials (RCTs), non-RCTs, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies. OUTCOMES The current review will consider studies that measure delay time as the main outcome. The time will be measured as the interval between the time of symptom onset and time to reach an ED. SEARCH STRATEGY A comprehensive search was undertaken for relevant published and unpublished studies written in English with no date restriction. All searches were conducted in October 2014. We searched the following databases: MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, ProQuest (health databases only), Informit, Sociological Abstracts, Scopus and Web of Science. The search for unpublished studies included a wide range of 'gray literature' sources including national libraries, digital theses repositories and clinical trial registries. We also targeted specific health research, specialist cardiac, migrant health, and emergency medicine organizational websites and/or conferences. We also checked the reference lists of included studies and contacted authors when further details about reported data was required to make a decision about eligibility. METHODOLOGICAL QUALITY Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to being included in the review. Validity was assessed using standardized critical appraisal instruments from the Joanna Briggs Institute. Adjudication was produced by the third reviewer. DATA EXTRACTION Data were extracted from included articles by two independent reviewers using the standardized data extraction tool from the Joanna Briggs Institute. DATA SYNTHESIS The extracted data were synthesized into a narrative summary. Meta-analysis could not be performed due to the heterogeneity of study protocols and methods used to measure outcomes. RESULTS A total of 10 studies, with a total of 1,511,382 participants, investigating the association between ethnicity and delay met the inclusion criteria. Delay times varied across ethnic groups, including Black, Hispanic, Asian, South Asian, Southeast Asian and Chinese. Seven studies reported delay in hours and ranged from 1.90 to 3.10 h. Delay times were longer among CALD populations than the majority population. The other three studies reported delay time in categories of time (e.g. <1, <4 and <6 h) and found larger proportions of later presentations to the EDs among ethnic groups compared with the majority groups. CONCLUSION There is evidence of an association between ethnicity and time taken in seeking medical care for chest pain, with patients from some ethnic minorities (e.g. Black, Asian, Hispanic and South Asian) taking longer than those of the majority population. Health promotions and health campaigns focusing on these populations are indicated.
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Affiliation(s)
- Kannikar Wechkunanukul
- 1School of Nursing and Midwifery, Flinders University, South Australia, Australia 2Centre for Evidence-based Practice South Australia: an Affiliate Centre of the Joanna Briggs Institute 3Paramedic Unit, School of Medicine, Flinders University, South Australia, Australia 4Flinders University Library, Flinders University, South Australia, Australia
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Nesoff ED, Brownstein JN, Veazie M, O'Leary M, Brody EA. Time-to-Treatment for Myocardial Infarction: Barriers and Facilitators Perceived by American Indians in Three Regions. J Community Health 2018; 42:129-138. [PMID: 27613739 DOI: 10.1007/s10900-016-0239-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Early recognition of acute myocardial infarction (MI), followed by prompt emergency care, improves patient outcomes. Among rural American Indian (AI) populations there are disparities in access to care for MI and processes of care, resulting in poor MI-related health outcomes compared to the general population. We sought to gain an understanding of barriers related to MI time-to-treatment delays using a qualitative approach. We conducted semi-structured interviews and focus groups with AI key informants and community members in three Indian Health Service regions. Major barriers to care included long travel distance to care and lack of supporting infrastructure; distrust of the health care system; low overall literacy and basic health literacy; priority of family care-giving; and lack of specialized medical facilities and specialists. Findings suggest that improved time-to-treatment facilitators include educating the local community about the causes and consequences of MI and culturally-sensitive health communication, as well as addressing the quality of local systems of care and the community's perception of these systems. Pursuing these strategies may improve quality of care and reduce MI-related morbidity and mortality in rural AI populations.
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Affiliation(s)
- Elizabeth D Nesoff
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | - J Nell Brownstein
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop F-72, Atlanta, GA, 30341-3717, USA
| | - Mark Veazie
- Indian Health Service, 1215 N. Beaver Street, Suite #201, Flagstaff, AZ, 86001, USA
| | - Marcia O'Leary
- Missouri Breaks Industries Research, HCR 64 Box 52, Timber Lake, SD, 57656, USA
| | - Eric A Brody
- Native American Cardiology and Medical Service Program, University of Arizona Medical Center, 1501 North, Campbell Ave., PO Box 245202, Tucson, AZ, 85724, USA
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Patterson F, Zhang G, Davey A, Tan Y, Ma GX. American Heart Association's Ideal Cardiovascular Health Metrics in Under-Represented Asian Americans. J Community Health 2016; 41:1282-1289. [PMID: 27363824 DOI: 10.1007/s10900-016-0217-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The American Heart Association's ideal cardiovascular health score is based on 7 cardiovascular health metrics to measure progress toward their Impact Goal of reducing cardiovascular disease by 20 % before 2020. This study applied this construct to assess cardiovascular health in a sample of Asian Americans. Convenience sampling methods were used to enroll self-identified Asian American's over the age of 18 years who were attending community health fairs across the greater Philadelphia and urban areas of New Jersey. The heart health metrics of tobacco use, body mass index, physical activity, diet, blood pressure, and glucose were measured. In the greater sample (N = 541), 82 % were female, the mean age was 65.1 (SD = 15.5) years, 45 % were Vietnamese, 38 % were Chinese and 17 % were Korean. Prevalence of ideal heart health for the metrics of tobacco use (95 %) was high. Only 19.4 % achieved ideal levels of physical activity, 35.1 % for BMI, 28.9 % for glucose and 66 % for blood pressure. Dietary intake was ideal for 20.7 % of the sample. More years since migration and Korean race trended toward having a higher prevalence of poor health in some metrics. Most Asian Americans are not achieving ideal cardiovascular health for several of the metrics evaluated, with those residing in the United States for more than 13 years and Korean Americans being higher-risk groups. Targeted community based intervention approaches to improving and monitoring heart health in Asian American, and Asian American subgroups, are needed.
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Affiliation(s)
- Freda Patterson
- College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Guo Zhang
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Adam Davey
- College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Yin Tan
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Grace X Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA. .,Department of Clinical Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19122-0843, USA.
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9
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Mehta LS, Beckie TM, DeVon HA, Grines CL, Krumholz HM, Johnson MN, Lindley KJ, Vaccarino V, Wang TY, Watson KE, Wenger NK. Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association. Circulation 2016; 133:916-47. [PMID: 26811316 DOI: 10.1161/cir.0000000000000351] [Citation(s) in RCA: 739] [Impact Index Per Article: 92.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiovascular disease is the leading cause of mortality in American women. Since 1984, the annual cardiovascular disease mortality rate has remained greater for women than men; however, over the last decade, there have been marked reductions in cardiovascular disease mortality in women. The dramatic decline in mortality rates for women is attributed partly to an increase in awareness, a greater focus on women and cardiovascular disease risk, and the increased application of evidence-based treatments for established coronary heart disease. This is the first scientific statement from the American Heart Association on acute myocardial infarction in women. Sex-specific differences exist in the presentation, pathophysiological mechanisms, and outcomes in patients with acute myocardial infarction. This statement provides a comprehensive review of the current evidence of the clinical presentation, pathophysiology, treatment, and outcomes of women with acute myocardial infarction.
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Rodriguez F, Foody JM, Wang Y, López L. Young Hispanic Women Experience Higher In-Hospital Mortality Following an Acute Myocardial Infarction. J Am Heart Assoc 2015; 4:e002089. [PMID: 26353998 PMCID: PMC4599495 DOI: 10.1161/jaha.115.002089] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Although mortality rates for acute myocardial infarction (AMI) have declined for men and women, prior studies have reported a sex gap in mortality such that younger women were most likely to die after an AMI. Methods and Results We sought to explore the impact of race and ethnicity on the sex gap in AMI patterns of care and mortality for younger women in a contemporary patient cohort. We constructed multivariable hierarchical logistic regression models to examine trends in AMI hospitalizations, procedures, and in-hospital mortality by sex, age (<65 and ≥65 years), and race/ethnicity (white, black, and Hispanic). Analyses were derived from 194 071 patients who were hospitalized for an AMI with available race and ethnicity data from the 2009–2010 National Inpatient Sample. Hospitalization rates, procedures (coronary angiography, percutaneous coronary interventions, and cardiac bypass surgery), and inpatient mortality were analyzed across age, sex, and race/ethnic groups. There was significant variation in hospitalization rates by age and race/ethnicity. All racial/ethnic groups were less likely to undergo invasive procedures compared with white men (P<0.001). After adjustment for comorbidities, younger Hispanic women experienced higher in-hospital mortality compared with younger white men, with an odds ratio of 1.5 (95% CI 1.2 to 1.9), adjusted for age and comorbidities. Conclusion We found significant racial and sex disparities in AMI hospitalizations, care patterns, and mortality, with higher in-hospital mortality experienced by younger Hispanic women. Future studies are necessary to explore determinants of these significant racial and sex disparities in outcomes for AMI.
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Affiliation(s)
- Fátima Rodriguez
- Division of Cardiovascular Medicine, Stanford UniversityStanford, CA
| | - JoAnne M Foody
- Harvard Medical School, Massachusetts General HospitalBoston, MA
- Division of Cardiovascular Medicine, Brigham and Women’s HospitalBoston, MA
| | - Yun Wang
- Department of Biostatistics, Harvard School of Public HealthBoston, MA
| | - Lenny López
- Harvard Medical School, Massachusetts General HospitalBoston, MA
- Mongan Institute for Health Policy, Massachusetts General HospitalBoston, MA
- Disparities Solutions Center, Massachusetts General HospitalBoston, MA
- Division of General Internal Medicine, Brigham and Women’s HospitalBoston, MA
- Correspondence to: Lenny López, MD, MPH, MDiv, Mongan Institute of Health Policy, Massachusetts General Hospital, 50 Staniford St., 9th Floor, Boston, MA 02114. E-mail:
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Sarwar E, Arias D, Becerra BJ, Becerra MB. Sociodemographic Correlates of Dietary Practices among Asian-Americans: Results from the California Health Interview Survey. J Racial Ethn Health Disparities 2015; 2:494-500. [PMID: 26863555 DOI: 10.1007/s40615-015-0097-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 02/09/2015] [Accepted: 02/27/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Studies show that Asian-American subgroups do not always meet dietary recommendations and are at high risk of cardiovascular diseases. The purpose of our research is to illustrate the various sociodemographic correlates of dietary habits for six subgroups of Asian-Americans in California. DESIGN The 2005 California Health Interview Survey (CHIS) was utilized. A total of 3772 Asian-Americans were included in this study, with the largest subgroup being Chinese (n = 1280; N = 913,798). The outcome variable for this study was dietary behavior defined as consuming five or more fruits and vegetables per day (5-a-day), provided by CHIS. Univariate and multivariable regression analyses were conducted accounting for complex survey design. RESULTS Being a female (Chinese, Filipina, Korean, and Vietnamese), not being married (Chinese), not being a college graduate (Chinese), living in poverty (South Asian), and speaking only English language at home (Chinese and Japanese) were associated with higher odds of not meeting a 5-a-day requirement. CONCLUSION Results highlighted several sociodemographic correlates to not meeting 5-a-day requirement among six Asian-American subgroups. Targeted health promotion measures for such at-risk groups should be implemented to improve dietary practices.
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Affiliation(s)
- Evangel Sarwar
- Department of Health Science and Human Ecology, California State University, 5500 University Parkway, San Bernardino, CA, 92407, USA.
| | - Devin Arias
- Department of Health Science and Human Ecology, California State University, 5500 University Parkway, San Bernardino, CA, 92407, USA.
| | | | - Monideepa Bhattacharya Becerra
- Department of Health Science and Human Ecology, California State University, 5500 University Parkway, San Bernardino, CA, 92407, USA.
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Krim SR, Vivo RP, Krim NR, Cox M, Hernandez AF, Peterson ED, Fonarow GC, Piña IL, Schwamm LH, Bhatt DL. Regional differences in clinical profile, quality of care, and outcomes among Hispanic patients hospitalized with acute myocardial infarction in the Get with Guidelines-Coronary Artery Disease (GWTG-CAD) registry. Am Heart J 2011; 162:988-995.e4. [PMID: 22137071 DOI: 10.1016/j.ahj.2011.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 09/08/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although Hispanics constitute the largest minority in the United States, it is unknown whether regional differences in quality of care and outcomes exist among Hispanic patients hospitalized with acute myocardial infarction (MI). METHODS Using the GWTG-CAD Registry, clinical characteristics, conformity with quality measures, and in-hospital outcomes were assessed among Hispanic patients from different geographic regions admitted for acute MI in participating hospitals. RESULTS A total of 11,299 Hispanic patients treated for acute MI at 277 hospitals from 4 regions were included in the study. Midwestern Hispanics were more likely to be younger, with male predominance in all regions. Northeastern Hispanics were more often insured with Medicaid. All subgroups showed high rates of hypertension, dyslipidemia, diabetes, and smoking, with the highest rates observed in the northeast region. Northeastern Hispanics were more likely to be discharged on angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, and statin or other lipid-lowering therapy. No significant regional differences were observed in aspirin, clopidogrel, and guideline-recommended door-to-balloon and door-to-thrombolysis times. Although Hispanics in the south and northeast were more likely to have a longer hospital stay compared with the west, there were no regional differences in in-hospital mortality. CONCLUSIONS Among Hispanics with acute MI enrolled in the GWTG-CAD program, there were modest regional differences in clinical profile; high rates of use and, with few exceptions, no regional differences in guideline-recommended therapies; and no regional variation in in-hospital mortality.
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Spectrum of cardiovascular diseases inAsian-American racial/ethnic subgroups. Ann Epidemiol 2011; 21:608-14. [PMID: 21737048 DOI: 10.1016/j.annepidem.2011.04.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 04/25/2011] [Accepted: 04/26/2011] [Indexed: 12/28/2022]
Abstract
PURPOSE To compare the prevalence of coronary heart disease (CHD), stroke, and peripheral vascular disease (PVD) across Asian-American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) and non-Hispanic white (NHW) subjects in a mixed-payer, outpatient health care organization in California. METHODS Electronic health records from 2007 to 2010 were examined for 94,423 Asian and NHW patients. Age-adjusted prevalence rates of CHD, stroke, and PVD, defined by physician International Classification of Diseases, Version 9, codes, were directly standardized to the NHW population. Age-adjusted odds ratios were calculated by the use of logistic regression for each Asian subgroup, by sex, compared with NHWs. RESULTS The range of age-adjusted prevalence rates were: CHD (1.7%-5.2%), stroke (0.3%-1.8%), and PVD (0.9%-3.4%). The adjusted odds ratios of CHD were significantly higher for Filipino women (1.66; 95% confidence interval; 1.13-2.43) and men (1.47, 1.05-2.06) and Asian Indian men (1.77, 1.43-2.21), and significantly lower for Chinese women (0.72, 0.55-0.94) and men (0.78, 0.65-0.93), compared with NHWs. The odds of stroke were significantly greater for Filipino women (2.02, 1.22-3.34). The odds of PVD were generally lower for all Asian subgroups. CONCLUSION There is considerable heterogeneity across Asian subgroups for prevalent CHD, stroke, and PVD. Future research should disaggregate Asian subgroups and cardiovascular outcomes to inform targeted prevention and treatment efforts.
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Sequist TD, Cullen T, Acton KJ. Indian Health Service Innovations Have Helped Reduce Health Disparities Affecting American Indian And Alaska Native People. Health Aff (Millwood) 2011; 30:1965-73. [DOI: 10.1377/hlthaff.2011.0630] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Thomas D. Sequist
- Thomas D. Sequist is an associate professor of medicine and health care policy at Harvard Medical School and Brigham and Women’s Hospital, in Boston, Massachusetts
| | - Theresa Cullen
- Theresa Cullen is the director of health domain information technology at the Department of Health and Human Services in Washington, D.C
| | - Kelly J. Acton
- Kelly J. Acton is the deputy regional health administrator for Department of Health and Human Services Region IX, in San Francisco, California
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Abstract
BACKGROUND Racial and ethnic disparities are well documented in many areas of health care, but have not been comprehensively evaluated among recipients of heart transplants. METHODS AND RESULTS We performed a retrospective cohort study of 39075 adult primary heart transplant recipients from 1987 to 2009 using national data from the United Network of Organ Sharing and compared mortality for nonwhite and white patients using the Cox proportional hazards model. During the study period, 8082 nonwhite and 30 993 white patients underwent heart transplantation. Nonwhite heart transplant recipients increased over time, comprising nearly 30% of transplantations since 2005. Nonwhite recipients had a higher clinical risk profile than white recipients at the time of transplantation, but had significantly higher posttransplantation mortality even after adjustment for baseline risk. Among the nonwhite group, only black recipients had an increased risk of death compared with white recipients after multivariable adjustment for recipient, transplant, and socioeconomic factors (hazard ratio, 1.34; 95% confidence interval, 1.21 to 1.47; P<0.001). Five-year mortality was 35.7% (95% confidence interval, 35.2 to 38.3) among black and 26.5% (95% confidence interval, 26.0 to 27.0) among white recipients. Black patients were more likely to die of graft failure or a cardiovascular cause than white patients, but less likely to die of infection or malignancy. Although mortality decreased over time for all transplant recipients, the disparity in mortality between blacks and whites remained essentially unchanged. CONCLUSIONS Black heart transplant recipients have had persistently higher mortality than whites recipients over the past 2 decades, perhaps because of a higher rate of graft failure.
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Affiliation(s)
- Vincent Liu
- Divisions of Pulmonary and Critical Care, Stanford University, CA, USA.
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16
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Bossaert L, O'Connor RE, Arntz HR, Brooks SC, Diercks D, Feitosa-Filho G, Nolan JP, Hoek TLV, Walters DL, Wong A, Welsford M, Woolfrey K. Part 9: Acute coronary syndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2011; 81 Suppl 1:e175-212. [PMID: 20959169 DOI: 10.1016/j.resuscitation.2010.09.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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17
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O'Connor RE, Bossaert L, Arntz HR, Brooks SC, Diercks D, Feitosa-Filho G, Nolan JP, Vanden Hoek TL, Walters DL, Wong A, Welsford M, Woolfrey K. Part 9: Acute coronary syndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010; 122:S422-65. [PMID: 20956257 DOI: 10.1161/circulationaha.110.985549] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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18
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Cardiac procedures among American Indians and Alaska Natives compared to non-Hispanic whites hospitalized with ischemic heart disease in California. J Gen Intern Med 2010; 25:430-4. [PMID: 20107917 PMCID: PMC2854994 DOI: 10.1007/s11606-009-1235-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 08/07/2009] [Accepted: 12/14/2009] [Indexed: 12/03/2022]
Abstract
BACKGROUND American Indians/Alaska Natives (AIAN) experience a high burden of cardiovascular disease with rates for fatal and nonfatal heart disease approximately twofold higher than the U.S. population. OBJECTIVE To determine if disparities exist in cardiac procedure rates among AIAN compared to non-Hispanic whites hospitalized in California for ischemic heart disease defined as acute myocardial infarction or unstable angina. DESIGN Cross-sectional study. EVENTS: A total of 796 ischemic heart disease hospitalizations among AIAN and 90971 among non-Hispanic whites in 37 of 58 counties in California from 1998-2002. MEASUREMENTS Cardiac catheterization, percutaneous cardiac intervention, and coronary artery bypass graft surgery procedure rates from hospitalization administrative data. MAIN RESULTS AIAN did not have lower cardiac procedure rates for cardiac catheterization and percutaneous cardiac intervention compared to non-Hispanic whites (unadjusted OR 1.00, 95% CI 0.87-1.16 and OR 1.04, 95% CI 0.90-1.20, respectively). Adjustment for age, sex, comorbidities, and payer source did not alter the results (adjusted OR 0.95, 95% CI 0.82-1.10 and OR 0.98, 95% CI 0.85-1.14, respectively). We found higher odds (unadjusted OR 1.36, 95% CI 1.09-1.70) for receipt of coronary artery bypass graft surgery among AIAN hospitalized for ischemic heart disease compared to non-Hispanic whites which after adjustment attenuated some and was no longer statistically significant (adjusted OR 1.26, 95% CI 1.00-1.58). CONCLUSION AIAN were not less likely to receive cardiac procedures as non-Hispanic whites during hospitalizations for ischemic heart disease. Additional research is needed to determine whether differences in specialty referral patterns, patients' treatment preferences, or outpatient management may explain some of the health disparities due to cardiovascular disease that is found among AIAN.
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19
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Lopez-Olivo MA, Gonzalez-Lopez L, Garcia-Gonzalez A, Villa-Manzano AI, Cota-Sanchez AR, Salazar-Paramo M, Varon-Villalpando E, Cardona-Muñoz EG, Gamez-Nava JI. Factors associated with hyperhomocysteinaemia in Mexican patients with rheumatoid arthritis. Scand J Rheumatol 2009; 35:112-6. [PMID: 16641044 DOI: 10.1080/03009740510026922] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hyperhomocysteinaemia is a factor related to the development of atherosclerosis in rheumatoid arthritis (RA). However, Hispanics with RA develop high rates of coronary disease; there are no studies about the frequency and factors related to high levels of homocysteine in Mexican patients. OBJECTIVE To evaluate the prevalence and characteristics associated with hyperhomocysteinaemia in Mexican patients with RA. METHODS One hundred and fifty-two patients with RA were compared with 153 controls. The assessment in RA included clinical characteristics, disease activity (RADAR), functioning (HAQ-Di and global functional status), comorbidity, and radiological damage. Laboratory determinations included total serum homocysteine (tHcy), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), and lipid profile. RESULTS Median levels of homocysteine were higher in RA compared with controls (11.3 vs. 9.3, p<0.001). Twenty per cent of the patients with RA had hyperhomocysteinaemia (>15 micromol/L) compared with 6% in controls (p<0.001). There was statistical association between hyperhomocysteinaemia in RA with male gender (p<0.001), impairment in the global functional status (p = 0.004), higher radiological damage (p = 0.001), and CRP (p = 0.04). There was no association with RADAR, HAQ-Di, or RF, methotrexate dose or duration of use. In the adjusted multivariate model, the two variables associated with higher risk for hyperhomocysteinaemia were male gender (OR = 4.2, 95% CI 2 to 12, p = 0.006) and higher radiological damage (III-IV) (OR = 3.4, 95% CI 1.3 to 9, p = 0.01). CONCLUSIONS Our data show a high prevalence of hyperhomocysteinaemia in Mexican patients with RA. More effort is required to evaluate and treat earlier this coronary risk factor.
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Affiliation(s)
- M A Lopez-Olivo
- Department of Internal Medicine, Rheumatology, Hospital General Regional 110, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Mexico
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20
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Stephen SA, Darney BG, Rosenfeld AG. Symptoms of acute coronary syndrome in women with diabetes: an integrative review of the literature. Heart Lung 2008; 37:179-89. [PMID: 18482629 DOI: 10.1016/j.hrtlng.2007.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Revised: 05/14/2007] [Accepted: 05/14/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To review studies comparing multiple acute coronary syndrome (ACS) symptoms in white and Latina women with and without diabetes. METHODS This empirical integrative review summarizes 8 studies and identifies the limitations of research to date. RESULTS There are conflicting results about acute coronary syndrome (ACS) symptoms in women with diabetes. Differences were found in associated ACS symptoms and symptom characteristics; however, some studies found no differences in frequency of chest pain by diabetic status. Diabetes is an independent predictor of "atypical" presentation of acute myocardial infarction in women, and research to date suggests that shortness of breath may be an important ACS symptom in women with diabetes. CONCLUSIONS There is a paucity of literature on ACS symptoms in women, particularly Latina women, with diabetes, and results are inconclusive. Future research should examine the full range of ACS symptoms in multiethnic samples of women with diabetes.
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Affiliation(s)
- Sharon A Stephen
- School of Nursing, Oregon Health & Science University, 3455 S.W. US Veterans Hospital Rd., Mail Code SN-5N, Portland, OR 97239-2941, USA
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21
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Atkinson MA, Neu AM, Fivush BA, Frankenfield DL. Ethnic disparity in outcomes for pediatric peritoneal dialysis patients in the ESRD Clinical Performance Measures Project. Pediatr Nephrol 2007; 22:1939-46. [PMID: 17876608 DOI: 10.1007/s00467-007-0593-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 06/22/2007] [Accepted: 07/18/2007] [Indexed: 11/29/2022]
Abstract
Ethnicity information was collected for all pediatric peritoneal dialysis patients from the End-Stage Renal Disease (ESRD) Clinical Performance Measures (CPM) Project for the period October 2004 through March 2005. Associations between intermediate outcomes and Hispanic ethnicity were determined. Thirty percent (207/696) of patients in the final cohort were Hispanic, 24% (165/696) non-Hispanic black, and 46% (324/696) non-Hispanic white. Hispanics were more likely to be female, older, and have a lower mean height standard deviation score (SDS). There were no significant differences among ethnic/racial groups regarding clearance parameters. More Hispanics had a mean hemoglobin > or = 11 g/dl compared with non-Hispanic blacks and non-Hispanic whites (77% vs. 55% and 70%, P < 0.0001). More Hispanics compared with non-Hispanic blacks and non-Hispanic whites had a mean serum albumin > or = 4.0/3.7 g/dl [bromcresol green/bromcresol purple laboratory method (BCG/BCP)] (50% vs. 24% and 27%, respectively, P < 0.0001). In multivariate analyses, Hispanics remained significantly more likely to achieve a mean serum albumin > or = 4.0/3.7 g/dl (BCG/BCP) compared with non-Hispanic whites (referent) and were as likely to achieve clearance and hemoglobin targets. Pediatric Hispanic peritoneal dialysis patients experience equivalent or better intermediate outcomes of dialytic care compared with non-Hispanics. Further study is needed to understand associations of Hispanic ethnicity with outcomes such as hospitalization, transplantation, and mortality.
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Affiliation(s)
- Meredith A Atkinson
- Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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22
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Moser DK, Kimble LP, Alberts MJ, Alonzo A, Croft JB, Dracup K, Evenson KR, Go AS, Hand MM, Kothari RU, Mensah GA, Morris DL, Pancioli AM, Riegel B, Zerwic JJ. Reducing delay in seeking treatment by patients with acute coronary syndrome and stroke: a scientific statement from the American Heart Association Council on Cardiovascular Nursing and Stroke Council. J Cardiovasc Nurs 2007; 22:326-43. [PMID: 17589286 DOI: 10.1097/01.jcn.0000278963.28619.4a] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient delay in seeking treatment for acute coronary syndrome and stroke symptoms is the major factor limiting delivery of definitive treatment in these conditions. Despite decades of research and public education campaigns aimed at decreasing patient delay times, most patients still do not seek treatment in a timely manner. In this scientific statement, we summarize the evidence that (1) demonstrates the benefits of early treatment, (2) describes the extent of the problem of patient delay, (3) identifies the factors related to patient delay in seeking timely treatment, and (4) reveals the inadequacies of our current approaches to decreasing patient delay. Finally, we offer suggestions for clinical practice and future research.
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Yeo KK, Li Z, Amsterdam E. Clinical characteristics and 30-day mortality among Caucasians, Hispanics, Asians, And African-Americans in the 2003 California coronary artery bypass graft surgery outcomes reporting program. Am J Cardiol 2007; 100:59-63. [PMID: 17599441 DOI: 10.1016/j.amjcard.2007.02.053] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 02/12/2007] [Accepted: 02/12/2007] [Indexed: 11/26/2022]
Abstract
The importance of differences in clinical characteristics between ethnic groups on operative mortality of coronary artery bypass grafting (CABG) has not been clarified. Data reporting to the California CABG outcomes reporting program is mandated under state law in California. Data from 121 hospitals in 2003 were analyzed, including clinical characteristics and predicted and observed operative mortalities in patients who underwent isolated CABG. In total 21,272 isolated CABGs were reported in 2003. Compared with Caucasians (n = 15,069), Hispanics (n = 2,561), Asians (n = 1,772), and African-Americans (n = 785) were younger, more likely to be women, and had more hypertension, diabetes, renal failure, and severe liver disease (all p values <0.05). Hispanics had more heart failure and Asians had a lower body mass index compared with Caucasians, whereas African-Americans had a higher body mass index and more peripheral artery disease and heart failure (all p values <0.05). Based on a multivariate model, the predicted operative mortality for Hispanics (3.2%), Asians (3.3%), and African-Americans (3.6%) was higher (all p values <0.001) than that of Caucasians (2.8%). However, observed operative mortality was similar across ethnic groups, although there was a trend toward higher mortality in Asians compared with Caucasians (3.5% vs 2.8%, p = 0.077). In conclusion, significant differences in risk profile for CABG exist across ethnicities. Although the predicted operative mortality for Hispanics, Asians, and African-Americans was significantly higher than that for Caucasians, there was no significant difference in the observed operative mortality.
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Affiliation(s)
- Khung Keong Yeo
- Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, California, USA
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24
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Echols MR, Mahaffey KW, Banerjee A, Pieper KS, Stebbins A, Lansky A, Cohen MG, Velazquez E, Santos R, Newby LK, Gurfinkel EP, Biasucci L, Ferguson JJ, Califf RM. Racial differences among high-risk patients presenting with non-ST-segment elevation acute coronary syndromes (results from the SYNERGY trial). Am J Cardiol 2007; 99:315-21. [PMID: 17261389 DOI: 10.1016/j.amjcard.2006.08.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Revised: 08/22/2006] [Accepted: 08/22/2006] [Indexed: 11/24/2022]
Abstract
Management and outcomes of patients with acute coronary syndromes (ACSs) may vary according to patient race and ethnicity. To assess racial differences in presentation and outcome in high-risk North American patients with non-ST-segment elevation (NSTE) ACS, we analyzed baseline racial/ethnic differences and all-cause death or nonfatal myocardial infarction (MI) in 6,077 white, 586 African-American, and 344 Hispanic patients through 30-day, 6-month, and 1-year follow-up. Frequencies of hypertension were 66% for whites, 83% for African-Americans, and 78% for Hispanics (overall p <0.001). Use of angiography was similar across groups. Use of percutaneous coronary intervention (46% for whites, 41% for African-Americans, and 45% for Hispanics, overall p = 0.046) and coronary artery bypass grafting (20% for whites, 16% for African-Americans, and 22% for Hispanics, overall p = 0.044) differed. African-American patients had significantly fewer diseased vessels compared with white patients (p = 0.0001). Thirty-day death or MI was 14% for whites, 10% for African-Americans, and 14% for Hispanics (overall p = 0.034). After adjustment for baseline variables, African-American patients had lower 30-day death or MI compared with white patients (odds ratio 0.73, 95% confidence interval 0.55 to 0.98). There were no differences in 6-month death or MI across racial/ethnic groups. In conclusion, baseline clinical characteristics differed across North American racial/ethnic groups in the SYNERGY trial. African-American patients had significantly better adjusted 30-day outcomes but similar 6-month outcomes compared with white patients.
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Affiliation(s)
- Melvin R Echols
- Duke Clinical Research Institute, Durham, North Carolina, USA
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25
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Moser DK, Kimble LP, Alberts MJ, Alonzo A, Croft JB, Dracup K, Evenson KR, Go AS, Hand MM, Kothari RU, Mensah GA, Morris DL, Pancioli AM, Riegel B, Zerwic JJ. Reducing Delay in Seeking Treatment by Patients With Acute Coronary Syndrome and Stroke. Circulation 2006; 114:168-82. [PMID: 16801458 DOI: 10.1161/circulationaha.106.176040] [Citation(s) in RCA: 443] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient delay in seeking treatment for acute coronary syndrome and stroke symptoms is the major factor limiting delivery of definitive treatment in these conditions. Despite decades of research and public education campaigns aimed at decreasing patient delay times, most patients still do not seek treatment in a timely manner. In this scientific statement, we summarize the evidence that (1) demonstrates the benefits of early treatment, (2) describes the extent of the problem of patient delay, (3) identifies the factors related to patient delay in seeking timely treatment, and (4) reveals the inadequacies of our current approaches to decreasing patient delay. Finally, we offer suggestions for clinical practice and future research.
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26
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Cohen MG, Roe MT, Mulgund J, Peterson ED, Sonel AF, Menon V, Smith SC, Saucedo JF, Lytle BL, Pollack CV, Garza L, Gibler WB, Ohman EM. Clinical characteristics, process of care, and outcomes of Hispanic patients presenting with non-ST-segment elevation acute coronary syndromes: results from Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines (CRUSADE). Am Heart J 2006; 152:110-7. [PMID: 16824839 DOI: 10.1016/j.ahj.2005.09.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Accepted: 09/07/2005] [Indexed: 12/16/2022]
Abstract
BACKGROUND Data regarding the management of non-ST-segment elevation acute coronary syndromes (NSTE ACS) in Hispanic patients, the largest and fastest-growing minority in the United States, are scarce. METHODS We sought to describe the clinical characteristics, process of care, and outcomes of Hispanics presenting with NSTE ACS at US hospitals. We compared baseline characteristics, resource use, and inhospital mortality among 3936 Hispanics and 90280 non-Hispanic whites with NSTE ACS from the CRUSADE Quality Improvement Initiative. RESULTS The regional distribution of Hispanics in CRUSADE paralleled that in the US Census. Hispanics were younger (65 vs 70 years, P < .0001) and had less hyperlipidemia (45.4% vs 49.0%, P < .0001) but were more likely to be hypertensive (72.2% vs 67.9%, P < .0001) and diabetic (46.5% vs 30.9%, P < .0001). Hispanics were also more likely to be uninsured (12.5% vs 5.1%, P < .001). During hospitalization, Hispanics were more often managed conservatively, undergoing stress tests more frequently (13.0% vs 10.1%, P < .0001), with less use of cardiac catheterization within 48 hours (48.7% vs 55.5%, P < .0001) or percutaneous coronary intervention (39.6% vs 46.4%, P < .0001) at any time. Hispanics received similar discharge treatments but were less frequently referred for cardiac rehabilitation (38.5% vs 49.2%, P < .0001). Adjusted inhospital mortality was similar in both groups (odds ratio 0.87, 95% CI 0.72-1.05). CONCLUSIONS Although hispanics have a different risk factor profile and are treated less aggressively during hospitalization when they present with NSTE ACS, these treatment differences do not appear to affect inhospital outcomes. Further research is warranted to explore the long-term consequences of these findings.
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Affiliation(s)
- Mauricio G Cohen
- Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7075, USA.
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Frankenfield DL, Atkinson MA, Fivush BA, Neu AM. Outcomes for Adolescent Hispanic Hemodialysis Patients: Findings From the ESRD Clinical Performance Measures Project. Am J Kidney Dis 2006; 47:870-8. [PMID: 16632027 DOI: 10.1053/j.ajkd.2006.01.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2005] [Accepted: 01/26/2006] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is limited information regarding outcomes of dialytic care for Hispanic adolescent hemodialysis patients. METHODS Ethnicity information was collected for all adolescent in-center hemodialysis patients for the Centers for Medicare & Medicaid Services 2000 End-Stage Renal Disease (ESRD) Clinical Performance Measures Project. Associations between intermediate outcomes and Hispanic ethnicity were determined. Associations of ethnicity and other demographic/clinical variables with hospitalization and transplantation during the 12-month follow-up period were examined. RESULTS Twenty-two percent of patients were identified as Hispanic; 40%, as non-Hispanic black; and 32%, as non-Hispanic white. Hispanic patients were younger and more likely to have congenital/urological causes of ESRD. More Hispanic patients had a mean single-pool Kt/V of 1.2 or greater compared with non-Hispanic blacks and non-Hispanic whites (87% versus 73% and 79%; P = 0.036). More Hispanic patients had a mean serum albumin level of 3.5/3.2 g/dL (bromcresol green/bromcresol purple method) or greater (> or = 35/32 g/L; 91% versus 82% and 76%; P = 0.017). More Hispanic patients compared with non-Hispanic blacks and non-Hispanic whites were dialyzed with a catheter for 90 days or longer (30% versus 21% and 23%; P = 0.027). In the final multivariate Cox proportional hazard models, Hispanic patients were at a slightly decreased risk for hospitalization compared with non-Hispanics (adjusted hazard ratio [adjHR], 0.63; P = 0.031) and were as likely to undergo a first transplantation as non-Hispanic whites (adjHR, 0.56; P = 0.099). CONCLUSION Adolescent Hispanic hemodialysis patients experience equivalent or better intermediate outcomes of dialytic care than non-Hispanics. They experienced a decreased risk for subsequent hospitalization and are as likely to undergo transplantation within 12 months as non-Hispanic whites.
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Affiliation(s)
- Diane L Frankenfield
- Centers for Medicare & Medicaid Services, Office of Clinical Standards and Quality, Baltimore, MD, USA
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28
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Sequist TD, Zaslavsky AM, Galloway JM, Ayanian JZ. Cardiac procedure use following acute myocardial infarction among American Indians. Am Heart J 2006; 151:909-14. [PMID: 16569561 DOI: 10.1016/j.ahj.2005.05.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Accepted: 05/10/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND The prevalence of coronary heart disease is rising among American Indians (AIs), but there is limited evidence describing processes of care for AI with acute myocardial infarction (AMI). We compared rates of cardiac catheterization, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) surgery between AI and whites with AMI. METHODS Using data from the Nationwide Inpatient Sample and the Indian Health Service National Patient Information Reporting System, we identified 2511 AI and 316,526 whites older than 30 years admitted with AMI during 1998 to 2001. Comparisons of cardiac procedure use between AI and whites were performed after adjusting for comorbid conditions and after stratifying by geographic region. RESULTS American Indians were less likely than whites to undergo cardiac catheterization and PCI in 3 of 4 geographic regions, with the largest difference occurring in the West South Central region (OR 0.32, 95% CI 0.24 to 0.43 for catheterization; OR 0.43, 95% CI 0.31 to 0.57 for PCI). American Indians were less likely than whites to undergo CABG surgery among diabetic patients (OR 0.48, 95% CI 0.32-0.73), but not among nondiabetic patients (OR 0.90, 95% CI 0.72-1.12). There were no differences in rates of PCI and CABG surgery between AIs and whites among those receiving cardiac catheterization. CONCLUSIONS Differences in the performance of coronary procedures are concentrated in western regions of the United States and are especially related to access to cardiac catheterization. Future studies are indicated to elucidate the mechanisms of these differences in care and their impact on clinical outcomes.
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Affiliation(s)
- Thomas D Sequist
- Division of General Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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Curtis JP, Portnay EL, Wang Y, McNamara RL, Herrin J, Bradley EH, Magid DJ, Blaney ME, Canto JG, Krumholz HM. The pre-hospital electrocardiogram and time to reperfusion in patients with acute myocardial infarction, 2000-2002: findings from the National Registry of Myocardial Infarction-4. J Am Coll Cardiol 2006; 47:1544-52. [PMID: 16630989 DOI: 10.1016/j.jacc.2005.10.077] [Citation(s) in RCA: 169] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Revised: 10/05/2005] [Accepted: 10/10/2005] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The aim of this study was to determine the use of pre-hospital electrocardiogram (ECG) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing reperfusion therapy, and evaluate the effect of pre-hospital ECG on door-to-reperfusion times. BACKGROUND Although national guidelines recommend the use of pre-hospital ECG, there is limited contemporary information about its current use and effectiveness. METHODS Using data from the National Registry of Myocardial Infarction-4, we studied patients with STEMI or left bundle branch block who received acute reperfusion with either fibrinolytic therapy (n = 35,370) or primary percutaneous coronary intervention (PCI) (n = 21,277) within 6 h of admission. We determined the prevalence of pre-hospital ECG use, evaluated the association between pre-hospital ECG and door-to-reperfusion time, and estimated the incremental reduction in time to reperfusion using hierarchical models to adjust for differences in patient and hospital characteristics. RESULTS A pre-hospital ECG was performed in 4.5% of the fibrinolytic therapy cohort and in 8.0% of the PCI cohort. After adjusting for patient and hospital characteristics, the use of pre-hospital ECG was associated with a significantly shorter geometric mean door-to-drug time: 24.6 min (95% confidence interval [CI]: 23.7 to 25.5) vs. 34.7 min (95% CI: 34.2 to 35.3; p < 0.0001), and a significantly shorter geometric mean door-to-balloon time (94.0 min [95% CI: 91.8 to 96.3] vs. 110.3 min [95% CI: 108.7 to 112.0]; p < 0.0001). CONCLUSIONS The national use of pre-hospital ECG to diagnose and facilitate the treatment of STEMI remains low. When used, however, pre-hospital ECG is associated with a significantly shorter time to reperfusion.
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Affiliation(s)
- Jeptha P Curtis
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8088, USA
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Hall YN, Sugihara JG, Go AS, Chertow GM. Differential mortality and transplantation rates among Asians and Pacific Islanders with ESRD. J Am Soc Nephrol 2005; 16:3711-20. [PMID: 16236803 DOI: 10.1681/asn.2005060580] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Few studies in patients with ESRD have examined outcomes in Asian or Pacific Islander subgroups compared with white individuals. The objective of this study was to assess ethnic disparities in mortality and kidney transplantation among a multiethnic cohort of incident dialysis patients. A total of 24,963 patients who initiated dialysis within the TransPacific Renal Network (Network 17) between April 1, 1995, and September 30, 2001, were studied to ascertain death and kidney transplantation through September 30, 2002. Overall, 12,902 deaths and 2258 kidney transplantations were observed during 59,075 person-years of follow-up. Mortality on dialysis among Asians and Pacific Islanders (except Chamorros) was lower than that of white individuals after controlling for differences in sociodemographic characteristics, comorbid conditions, and other risk factors for death (adjusted hazard ratio [95% confidence interval] versus white individuals: Japanese 0.64 [0.57 to 0.72], Chinese 0.64 [0.52 to 0.78], Filipino 0.64 [0.57 to 0.72], Native Hawaiian 0.84 [0.72 to 0.96], Samoan 0.62 [0.48 to 0.82], and Chamorro 0.96 [0.84 to 1.20]). In contrast, Asians and Pacific Islanders were much less likely to undergo kidney transplantation (adjusted rate ratio [95% confidence interval] versus white individuals: Japanese 0.34 [0.24 to 0.46], Chinese 0.54 [0.30 to 0.88], Filipino 0.32 [0.26 to 0.47], Native Hawaiian 0.17 [0.10 to 0.30], Samoan 0.17 [0.07 to 0.38], and Chamorro 0.04 [0.01 to 0.14]). Despite wide variations in primary cause of ESRD, clinical characteristics, and body size at dialysis initiation, Asians and Pacific Islanders experience better survival but substantially lower transplantation rates compared with white individuals. Strategies that are aimed at improving access to transplantation in Asian and Pacific Islander communities may further enhance survival among Asians and Pacific Islanders with ESRD.
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Affiliation(s)
- Yoshio N Hall
- Departments of Medicine, University of California San Francisco, San Francisco, CA 94118-1211, USA
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Yancy CW, Benjamin EJ, Fabunmi RP, Bonow RO. Discovering the full spectrum of cardiovascular disease: Minority Health Summit 2003: executive summary. Circulation 2005; 111:1339-49. [PMID: 15769779 DOI: 10.1161/01.cir.0000157740.93598.51] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Miller CD, Lindsell CJ, Anantharaman V, Lim SH, Greenway J, Pollack CV, Tiffany BR, Hollander JE, Gibler WB, Hoekstra JW. Performance of a population-based cardiac risk stratification tool in Asian patients with chest pain. Acad Emerg Med 2005; 12:423-30. [PMID: 15863398 DOI: 10.1197/j.aem.2004.11.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Most contemporary cardiac risk stratification tools have been derived and validated in mixed-race populations. Their validity in single-race populations has not been tested. The authors sought to compare the performance of a risk stratification tool between a mixed-race U.S. patient population and an Asian patient population. METHODS This study is an analysis of data from the Internet Tracking Registry for Acute Coronary Syndromes (i(*)trACS) registry of patients with chest pain presenting to the emergency departments of eight U.S. centers and one site in Singapore. The Acute Cardiac Ischemia Time-Insensitive Predictive Instrument (ACI-TIPI) was computed for included patients, and its performance in predicting acute coronary syndrome (ACS) was compared between patients from the United States and Singapore. RESULTS Of the 11,991 included patients, 1,120 experienced ACS. Although the ACI-TIPI demonstrated similar accuracy among groups (area under the curve, 0.729 [U.S.] vs. 0.719 [Singapore]; p = 0.5611), sensitivity and specificity were different when equal ACI-TIPI thresholds were considered. Recreating the logistic regression models used to create the ACI-TIPI showed similar results between the derived parameters and the parameters estimated for the U.S. group. In contrast, age older than 50 years (log-odds ratio [LOR], 0.107; 95% confidence interval [CI] = 0.518 to 0.713), male gender (LOR, 0.487; 95% CI = 0.149 to 1.122), and chest pain as a primary complaint (LOR, 0.237; 95% CI = 0.139 to 0.613) had little predictive power in patients from Singapore. CONCLUSIONS Differences exist in presentation and factors associated with ACS among patients from the United States and Singapore that may affect the performance of risk stratification tools. These findings suggest that cardiac clinical decision rules need international validation.
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Affiliation(s)
- Chadwick D Miller
- Department of Emergency Medicine, Wake Forest University Health Sciences, Medical Center Boulevard, Winston Salem, NC 27157-1089, USA.
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Cromwell J, McCall NT, Burton J, Urato C. Race/Ethnic Disparities in Utilization of Lifesaving Technologies by Medicare Ischemic Heart Disease Beneficiaries. Med Care 2005; 43:330-7. [PMID: 15778636 DOI: 10.1097/01.mlr.0000156864.80880.aa] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to explain race/ethnic disparities in hospitalizations, utilization of high-technology diagnostic and revascularization services, and mortality of elderly ischemic heart disease (IHD) patients. DESIGN A longitudinal Medicare claims database of all Part A hospital and Part B physician services provided elderly patients admitted for IHD in 1997 is used to construct admission, utilization, and mortality rates for whites and blacks, Asians, Hispanics, and American Indians. Z-scores are used to test differences in rates between whites and minorities at the 99% confidence level. Logistic and proportional hazard models are used to predict the likelihood of revascularization and its effects on race/ethnic survival 2 years postdischarge. SETTING The setting of this study was an acute hospital supplemented by all ambulatory Part B outpatient providers of care. PATIENTS/PARTICIPANTS Participants included all 700,000 age 65+ Medicare beneficiaries in fee-for-service identified with IHD as a primary diagnosis on admission in 1997. MEASUREMENTS AND MAIN RESULTS Whites were 26% more likely to be admitted for IHD than blacks, 50% more likely than Asians, 5% more than American Indians, but 3% less likely than Hispanics. Once admitted, elderly blacks and American Indians undergo invasive diagnostic and surgical revascularization far less often than whites (P < 0.01), although blacks are equally as likely as whites to be admitted to an open heart hospital. Controlling for other factors, whites reduce their 2-year mortality by 20% by undergoing revascularization 41% of the time. Blacks gain only 11% as a result of much lower rates and gains to revascularization than whites. Asians and Hispanics were slightly more likely than whites to undergo revascularization but gain less than whites from the procedure. CONCLUSIONS Despite having similar Medicare health insurance coverage, elderly utilization and IHD mortality rates differ markedly not only between whites and minorities, but within minority groups themselves. A large, nationally representative survey of physicians and patients is needed to distinguish between systemwide "failures to refer" and patient "aversions to surgery" as explanations for lower black rates of surgical interventions.
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Affiliation(s)
- Jerry Cromwell
- Research Triangle Institute, Waltham, Massachusetts, USA.
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Murthy BVR, Molony DA, Stack AG. Survival Advantage of Hispanic Patients Initiating Dialysis in the United States Is Modified by Race. J Am Soc Nephrol 2005; 16:782-90. [PMID: 15677309 DOI: 10.1681/asn.2004080627] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Differences in survival have been reported among ethnic groups in the general population. Whether these extend to patients with ESRD is unclear. Using national data, mortality risks of ethnic groups who began dialysis treatment in the United States between May 1, 1995, and July 31, 1997, were compared over 2 yr. Patients were classified as Hispanic or non-Hispanic and then subclassified by race forming six race-specific subgroups: Hispanic white, black, and other and non-Hispanic white, black, and other. Mortality rates for Hispanics compared with non-Hispanics were 19.2 versus 26 per 100 patient-years at risk for those with diabetes and were 14.7 versus 22.7 per 100 patient-years at risk for those without diabetes. For those with diabetes, adjusted mortality risks for Hispanics versus non-Hispanics were 30% lower (95% confidence interval [CI], 26 to 34%). In subgroup analysis, mortality risks for Hispanic whites and Hispanic blacks were 35% (95% CI, 31 to 39%) and 33% (95% CI, 12 to 48%) lower than non-Hispanic whites and were similar in magnitude to those of non-Hispanic blacks (32% lower; 95% CI, 29 to 35%) and non-Hispanic other (33% lower; 95% CI, 28 to 39%). Interestingly, mortality risks for Hispanic others were not significantly different from non-Hispanic whites. For those without diabetes, adjusted mortality risks for Hispanics versus non-Hispanics were 17% lower (95% CI, 9 to 23%), and subgroup analysis yielded similar patterns to those of individuals with diabetes. The survival advantage of Hispanic over non-Hispanic patients who receive chronic dialysis treatment in the United States is not consistent across subgroups and is modified by race. Cultural and genetic differences as well as variation in the access and delivery of care before and while on dialysis may account for these differences.
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Affiliation(s)
- Bhamidipati V R Murthy
- Department of Internal Medicine, Division of Renal Diseases and Hypertension, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.148, Houston, TX 77030, USA.
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Yarzebski J, Bujor CF, Lessard D, Gore JM, Goldberg RJ. Recent and temporal trends (1975 to 1999) in the treatment, hospital, and long-term outcomes of Hispanic and non-Hispanic white patients hospitalized with acute myocardial infarction: a population-based perspective. Am Heart J 2004; 147:690-7. [PMID: 15077086 DOI: 10.1016/j.ahj.2003.10.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Extremely limited population-based data are available describing recent and temporal trends in the characteristics, treatment, and outcomes of Hispanic and non-Hispanic white patients hospitalized with acute myocardial infarction (AMI). METHODS This was a community-based, observational study of 9649 greater Worcester residents hospitalized in all hospitals serving the Worcester, Massachusetts, metropolitan area in 12 one-year periods between 1975 and 1999. In the total study sample, 171 (2%) patients were Hispanic. Hispanic patients were matched with 395 non-Hispanic white patients on the basis of age, sex, and year of hospitalization. RESULTS Hispanics were more likely to present to greater Worcester hospitals with a history of diabetes as compared with non-Hispanic whites. Hispanics were less likely to have an initial, Q-wave AMI during the index hospitalization. After controlling for a limited number of known potentially confounding factors, Hispanics were at lower risk for development of heart failure (OR, 0.63; 95% CI, 0.41, 0.96). Both Hispanics (13% vs 11%) and non-Hispanic whites (28% vs 9%), however, had declines in hospital case-fatality rates between 1975 and 1999. An overall similar treatment pattern and increasing trends in the use of effective cardiac medications over time were observed in both patient groups. However, Hispanics were significantly less likely to be treated with coronary angioplasty during the acute hospitalization. Trends of a worse long-term survival for discharged Hispanic patients were observed over a 10-year follow-up period. CONCLUSIONS The results of this community-wide study suggest encouraging hospital outcomes in Hispanic and non-Hispanic white patients hospitalized with AMI. Enhanced secondary prevention efforts remain needed to improve the hospital and long-term outcomes of patients with AMI, irrespective of race or ethnicity.
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Affiliation(s)
- Jorge Yarzebski
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester 01655, USA.
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Gula L, Dick A, Massel D. Coron Artery Dis 2003; 14:387-393. [DOI: 10.1097/00019501-200308000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register]
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Gula LJ, Dick A, Massel D. Diagnosing acute myocardial infarction in the setting of left bundle branch block: prevalence and observer variability from a large community study. Coron Artery Dis 2003; 14:387-93. [PMID: 12878904 DOI: 10.1097/01.mca.0000085135.16622.e8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the known benefit of thrombolysis it remains under-utilized among eligible patients with acute myocardial infarction (AMI) and left bundle branch block (LBBB). We sought to determine the test characteristics and observer reliability of well-known criteria for the diagnosis of AMI when LBBB is present on the electrocardiogram (ECG). METHODS Four hundred and fourteen ECGs with LBBB from a large cohort of AMI patients (7.4% of the total) and 85 ECGs with LBBB not in the setting of acute coronary syndromes were interpreted for the presence of the Sgarbossa criteria. RESULTS Agreement for the various Sgarbossa criteria ranged from only fair to moderate. The three-way comparison kappa values were significantly better for ST depression than for both discordant (P<0.001) and concordant (P=0.001) ST-segment elevation. Concordant ST-segment elevation [6.3%, 95% confidence interval (CI) 4.3-9.1%] and depression (3.1%, 95% CI 1.8-5.4%) were infrequently seen in the setting of AMI and rarely seen otherwise. Discordant ST-segment elevation was seen more frequently (19.0%, 95% CI 15.5-23.1%). Concordant ST elevation and ST depression in V1-V3 were highly specific, but insensitive, for the diagnosis of AMI. The presence of discordant ST elevation was neither sensitive nor specific. CONCLUSION The low prevalence, poor sensitivity and marked observer variability make the Sgarbossa criteria for AMI in the setting of LBBB less than adequate. Although use of these criteria would be an advance over contemporary practice, it would still fall short among this high-risk subset.
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Affiliation(s)
- Lorne J Gula
- Department of Medicine, University of Western Ontario, London, Canada
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Frankenfield DL, Rocco MV, Roman SH, McClellan WM. Survival advantage for adult Hispanic hemodialysis patients? Findings from the end-stage renal disease clinical performance measures project. J Am Soc Nephrol 2003; 14:180-6. [PMID: 12506150 DOI: 10.1097/01.asn.0000037400.83593.e6] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
One-year follow-up mortality in Hispanic and non-Hispanic patients and its association with intermediate outcomes of dialytic care were examined utilizing the Center for Medicare & Medicaid Services' (CMS) ESRD Clinical Performance Measures (CPM) Project and administrative data. Demographic and clinical information was collected on a national random sample of adult in-center hemodialysis (HD) patients for the period of October through December, 1998. Patients were categorized as Hispanic, non-Hispanic White, or non-Hispanic Black. Of 8336 patients 994 (12%) were identified as Hispanic, 3618 (43%) as non-Hispanic White, and 3111 (37%) as non-Hispanic Black. The adjusted 12-mo mortality risk (99% CI) for Hispanics was 0.76 (0.60 to 0.96; P < 0.01) and for non-Hispanic Blacks 0.66 (0.56 to 0.78, P < 0.001) compared with non-Hispanic Whites (referent). Similar 12-mo mortality risks were noted in the groups with diabetes mellitus or hypertension as the causes of ESRD and among patients > or = 65 yr. After controlling for demographic and geographic variables, Hispanics compared with the referent group, non-Hispanic Whites, were more likely to have a mean serum albumin > or = 4.0/3.7 g/dL (BCG/BCP) (1.5 [1.2 to 1.7]; P < 0.001) and as likely to have a mean Kt/V > or = 1.2, mean hemoglobin > or = 11 g/dL, and an arteriovenous fistula as their vascular access. These data suggest that adult Hispanic HD patients have a 12-mo survival intermediate to non-Hispanic Blacks and non-Hispanic Whites and experience equivalent or better intermediate outcomes of dialytic care compared with non-Hispanic Whites.
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Affiliation(s)
- Diane L Frankenfield
- Centers for Medicare & Medicaid Services, Center for Beneficiary Choices, Baltimore, Maryland 21244, USA.
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Taylor HA, Hughes GD, Garrison RJ. Cardiovascular disease among women residing in rural America: epidemiology, explanations, and challenges. Am J Public Health 2002; 92:548-51. [PMID: 11919049 PMCID: PMC1447114 DOI: 10.2105/ajph.92.4.548] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Many believe that the United States has entered a "Golden Age" of cardiovascular health and medicine. Pharmacological and technological advances have indeed produced an era of declining mortality rates from cardiovascular diseases for the nation as a whole. However, there remain areas of challenge. Cardiovascular disease (CVD) is still by far the leading cause of death and disability in the United States, and it is the leading killer of US women. Perhaps the single most notable feature of the CVD epidemic in the United States is the substantial difference in morbidity and mortality that exists between White women and women of color, with a disproportionate share of suffering borne by minority women. Unexplained regional variations also cloud the otherwise notable progress of the last 30 years, and many rural areas appear to be uniquely affected by cardiovascular disease. This commentary reviews the evidence that the CVD epidemic disproportionately burdens women of color who reside in rural areas, itemizes and provides a logical framework for explaining this burden, and suggests approaches to solving this vexing public health problem.
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Affiliation(s)
- Herman A Taylor
- Jackson Heart Study, 350 West Woodrow Wilson Drive, Suite 701, Jackson, MS 39213, USA.
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Stryer DB. The development and role of predictive instruments in acute coronary events: improving diagnosis and management. J Cardiovasc Nurs 2002; 16:1-8. [PMID: 11958440 DOI: 10.1097/00005082-200204000-00002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The diagnosis and management of acute myocardial infarction and unstable angina pectoris are frequent challenges for emergency department staff. Strategies must quickly and accurately identify all patients requiring admission, monitoring, and reperfusion therapy to maximize outcomes without overdiagnosing. The Acute Cardiac Ischemia Time-Insensitive Predictive Instrument and the Thrombolytic Predictive Instrument are two decision-support tools designed to address this need. The instruments have been shown to improve some measures of the appropriateness of and time to emergency department triage. Prospective trials will be completed soon that will examine their effects on morbidity and mortality.
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Affiliation(s)
- Daniel B Stryer
- Center for Outcomes and Effectiveness Research, Agency for Healthcare Research and Quality, Rockville, Maryland, USA
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Cohen MG, Granger CB, Ohman EM, Stebbins AL, Grinfeld LR, Cagide AM, Elizari MV, Betriu A, Kong DF, Topol EJ, Califf RM. Outcome of Hispanic patients treated with thrombolytic therapy for acute myocardial infarction: results from the GUSTO-I and III trials. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries. J Am Coll Cardiol 1999; 34:1729-37. [PMID: 10577563 DOI: 10.1016/s0735-1097(99)00433-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We sought to describe the differences in the process of care and clinical outcomes between Hispanics and non-Hispanics receiving thrombolytic therapy for myocardial infarction (MI). BACKGROUND Hispanics are the fastest growing and second largest minority in the U.S. but most cardiovascular disease data on Hispanics has been derived from retrospective studies and vital statistics. Despite their higher cardiovascular risk-factor profile, better outcomes after MI have been reported in Hispanics. METHODS We studied the baseline characteristics, resource use and outcomes of 734 Hispanics and 27,054 non-Hispanics treated for MI in the GUSTO-I and -III trials. The primary end point of both trials was 30-day mortality. RESULTS Hispanics were younger, shorter, lighter and more often diabetic and began thrombolysis 9 min later, compared with non-Hispanics. Measures of socioeconomic status (educational level, employment and health insurance) were lower among Hispanics. Fewer Hispanics than non-Hispanics underwent in-hospital angiography (70% vs. 74%, p = 0.013) or bypass surgery (11% vs. 13.5%, p = 0.04). Hispanics received more angiotensin-converting enzyme (ACE) inhibitors and less calcium-channel blockers, prophylactic lidocaine and inotropic agents. Mortality at 30 days and at one year did not differ significantly between Hispanics and non-Hispanics (6.4% vs. 6.7% and 9.0% vs. 9.7%, respectively). We noted no interactions between thrombolytic strategy and Hispanic status on major outcomes (30-day death, stroke and major bleeding). CONCLUSIONS The care of Hispanics with MI differed slightly from that of non-Hispanics. Nevertheless, these differences in care did not affect long-term outcomes.
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Affiliation(s)
- M G Cohen
- Duke Clinical Research Institute, Durham, North Carolina, USA.
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