Racial and ethnic differences in time to acute reperfusion therapy for patients hospitalized with myocardial infarction.
JAMA
; 292(13): 1563-72, 2004 Oct 06.
Article
em En
| MEDLINE
| ID: mdl-15467058
ABSTRACT
CONTEXT Nonwhite patients experience significantly longer times to fibrinolytic therapy (door-to-drug times) and percutaneous coronary intervention (door-to-balloon times) than white patients, raising concerns of health care disparities, but the reasons for these patterns are poorly understood. OBJECTIVES:
To estimate race/ethnicity differences in door-to-drug and door-to-balloon times for patients receiving primary reperfusion for ST-segment elevation myocardial infarction; to examine how sociodemographic factors, insurance status, clinical characteristics, and hospital features mediate racial/ethnic differences. DESIGN, SETTING, AND PATIENTS Retrospective, observational study using admission and treatment data from the National Registry of Myocardial Infarction (NRMI) for a US cohort of patients with ST-segment elevation myocardial infarction or left bundle-branch block and receiving reperfusion therapy. Patients (73,032 receiving fibrinolytic therapy; 37,143 receiving primary percutaneous coronary intervention) were admitted from January 1, 1999, through December 31, 2002, to hospitals participating in NRMI 3 and 4. MAIN OUTCOMEMEASURE:
Minutes between hospital arrival and acute reperfusion therapy.RESULTS:
Door-to-drug times were significantly longer for patients identified as African American/black (41.1 minutes), Hispanic (36.1 minutes), and Asian/Pacific Islander (37.4 minutes), compared with patients identified as white (33.8 minutes) (P<.01 for all). Door-to-balloon times for patients identified as African American/black (122.3 minutes) or Hispanic (114.8 minutes) were significantly longer than for patients identified as white (103.4 minutes) (P<.001 for both). Racial/ethnic differences were still significant but were substantially reduced after accounting for differences in mean times to treatment for the hospitals in which patients were treated; significant racial/ethnic differences persisted after further adjustment for sociodemographic characteristics, insurance status, and clinical and hospital characteristics (P<.01 for all).CONCLUSION:
A substantial portion of the racial/ethnic disparity in time to treatment was accounted for by the specific hospital to which patients were admitted, in contrast to differential treatment by race/ethnicity inside the hospital.
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Base de dados:
MEDLINE
Assunto principal:
Admissão do Paciente
/
Estudos de Tempo e Movimento
/
Angioplastia Coronária com Balão
/
Terapia Trombolítica
/
Avaliação de Resultados em Cuidados de Saúde
/
Infarto do Miocárdio
Idioma:
En
Ano de publicação:
2004
Tipo de documento:
Article