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	Full Text PDF PDA Full Text Editorial by Lurie, N. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

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

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

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

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

Source Information

From the Department of Medicine, Division of Cardiology (V.V., N.K.W., J.L.A.) and Division of General Medicine (S.M.), Emory University School of Medicine; and the Department of Epidemiology, Rollins School of Public Health, Emory University (V.V.), Atlanta; the Section of Cardiovascular Medicine, Department of Medicine (S.S.R., H.M.K.), the Division of Health Policy and Administration, Department of Epidemiology and Public Health (H.M.K.), and the Robert Wood Johnson Clinical Scholars Program (H.M.K.) at Yale University School of Medicine and Yale–New Haven Hospital Center for Outcomes Research and Evaluation — both in New Haven, Conn.; the Ovation Research Group, Seattle (P.D.F.); Genentech, South San Francisco, Calif. (H.V.B.); and Hackley Hospital, Spring Lake, Mich. (A.M.).

Address reprint requests to Dr. Vaccarino at the Department of Medicine, Division of Cardiology, Emory University School of Medicine, 1256 Briarcliff Rd., Suite 1N, Atlanta, GA 30306, or at viola.vaccarino{at}emory.edu.

Full Text of this Article

Related Letters:

Trends in Racial Disparities in Care
Kuller L. H., Freedman B. I., Wagenknecht L. E., Bowden D. W., Keppel K. G., Pearcy J. N., Weissman J. S., Akpunonu B. E., Mutgi A. B., Khuder S. A., Vaccarino V., the National Registry of Myocardial Infarction Investigators , Jha A. K., Epstein A. M., Orav E. J., Trivedi A. N., Zaslavsky A. M., Ayanian J. Z.
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N Engl J Med 2005; 353:2081-2085, Nov 10, 2005. Correspondence

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