Department of Quantitative Health Sciences; Department of Medicine, Division of Cardiovascular Medicine; Department of Medicine, Division of Geriatric Medicine; Meyers Primary Care Institute
Cardiology | Cardiovascular Diseases | Epidemiology | Health Services Administration | Preventive Medicine
The objectives of this longitudinal study were to examine differences between whites and blacks, and across two geographical regions, in the socio-demographic, clinical, and psychosocial characteristics, hospital treatment practices, and post-discharge mortality for hospital survivors of an acute coronary syndrome (ACS). In this prospective cohort study, we performed in-person interviews and medical record abstractions for patients discharged from the hospital after an ACS at participating sites in Central Massachusetts and Central Georgia during 2011-2013. Among the 1143 whites in Central Massachusetts, 514 whites in Central Georgia, and 277 blacks in Central Georgia, we observed a gradient of socioeconomic position with whites in Central Massachusetts being the most privileged, followed by whites and then blacks from Central Georgia; similar gradients pertained to psychosocial vulnerability (e.g., 10.7%, 25.1%, and 49.1% had cognitive impairment, respectively) and to the hospital receipt of all 4 evidence-based cardiac medications (35.5%, 18.1%, and 14.4%, respectively) used in the acute management of patients hospitalized with an ACS. Multivariable adjusted odds ratios (95% confidence intervals) for the receipt of a percutaneous coronary intervention for whites and blacks in Georgia vs. whites in Massachusetts were 0.57 (0.46-0.71) and 0.40(0.30-0.52), respectively. Thirty-day and one-year mortality risks exhibited a similar gradient. The results of this contemporary clinical/epidemiologic study in a diverse patient cohort suggest that racial and geographic disparities continue to exist for patients hospitalized with an ACS.
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© 2017 The Authors. Published by Elsevier Inc. Citation: Prev Med Rep. 2017 Jan 24;6:1-8. doi: 10.1016/j.pmedr.2017.01.010. eCollection 2017. Link to article on publisher's site
Acute coronary syndromes, Longitudinal study, Race and geographic differences
Goldberg, Robert J.; Gore, Joel M.; McManus, David D.; McManus, Richard H.; Tisminetzky, Mayra; Lessard, Darleen M.; Gurwitz, Jerry H.; Parish, David C.; Allison, Jeroan J.; Hess, Connie Ng; Wang, Tracy; and Kiefe, Catarina I., "Race and place differences in patients hospitalized with an acute coronary syndrome: Is there double jeopardy? Findings from TRACE-CORE" (2017). University of Massachusetts Medical School Faculty Publications. 1210.
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