BACKGROUND: The underlying reasons why African American patients have a significantly higher mortality rate than European American patients after a myocardial infarction (MI) remain unclear. This study examined the racial disparity in mortality rates after MI and possible explanatory factors. METHODS: A prospective analysis was conducted within the Atherosclerosis Risk in Communities (ARIC) study, a community-based study of 15,792 middle-aged adults. From 1987 to 1998, 642 patients (471 European American and 171 African American) hospitalized for MI without prior history of MI were identified. Of these 642 patients, 129 (82 European American and 47 African American) died during follow-up. RESULTS: Cox proportional hazard models were used to analyze the racial difference in mortality rate after MI. After adjusting for age and sex, the relative hazard (RH) comparing African American patients to European American patients was 1.80 (95% CI, 1.24-2.61). The RH decreased after adjusting for vascular risk factors (1.29; 95% CI, 0.83-2.00), socioeconomic position (1.31; 95% CI, 0.83-2.09), severity of MI (1.60; 95% CI, 1.05-2.45), and treatment (1.36; 95% CI, 0.92-2.00). In the final model, which included all factors aforementioned, the RH for race was 1.00 (95% CI, 0.56-1.77). CONCLUSIONS: Our findings suggested that vascular risk factors, socioeconomic position, and treatment play major roles in the racial disparity in mortality rate after MI.
BACKGROUND: The underlying reasons why African American patients have a significantly higher mortality rate than European American patients after a myocardial infarction (MI) remain unclear. This study examined the racial disparity in mortality rates after MI and possible explanatory factors. METHODS: A prospective analysis was conducted within the Atherosclerosis Risk in Communities (ARIC) study, a community-based study of 15,792 middle-aged adults. From 1987 to 1998, 642 patients (471 European American and 171 African American) hospitalized for MI without prior history of MI were identified. Of these 642 patients, 129 (82 European American and 47 African American) died during follow-up. RESULTS: Cox proportional hazard models were used to analyze the racial difference in mortality rate after MI. After adjusting for age and sex, the relative hazard (RH) comparing African American patients to European American patients was 1.80 (95% CI, 1.24-2.61). The RH decreased after adjusting for vascular risk factors (1.29; 95% CI, 0.83-2.00), socioeconomic position (1.31; 95% CI, 0.83-2.09), severity of MI (1.60; 95% CI, 1.05-2.45), and treatment (1.36; 95% CI, 0.92-2.00). In the final model, which included all factors aforementioned, the RH for race was 1.00 (95% CI, 0.56-1.77). CONCLUSIONS: Our findings suggested that vascular risk factors, socioeconomic position, and treatment play major roles in the racial disparity in mortality rate after MI.
Authors: Comilla Sasson; Carla C Keirns; Dylan M Smith; Michael R Sayre; Michelle L Macy; William J Meurer; Bryan F McNally; Arthur L Kellermann; Theodore J Iwashyna Journal: Resuscitation Date: 2011-03-31 Impact factor: 5.262
Authors: Olivia R Henry; Hamed Benghuzzi; Herman A Taylor; Michelle Tucci; Kenneth Butler; Lynne Jones Journal: Am J Med Sci Date: 2012-08 Impact factor: 2.378
Authors: Comilla Sasson; David J Magid; Paul Chan; Elisabeth D Root; Bryan F McNally; Arthur L Kellermann; Jason S Haukoos Journal: N Engl J Med Date: 2012-10-25 Impact factor: 91.245
Authors: John A Spertus; Philip G Jones; Frederick A Masoudi; John S Rumsfeld; Harlan M Krumholz Journal: Ann Intern Med Date: 2009-03-03 Impact factor: 25.391
Authors: J Walker Blackston; Monika M Safford; Matthew T Mefford; Elizabeth Freeze; George Howard; Virginia J Howard; David C Naftel; Todd M Brown; Emily B Levitan Journal: Circ Cardiovasc Qual Outcomes Date: 2020-12-11
Authors: Robert J Goldberg; Joel M Gore; David D McManus; Richard McManus; Mayra Tisminetzky; Darleen Lessard; Jerry H Gurwitz; David C Parish; Jeroan Allison; Connie Ng Hess; Tracy Wang; Catarina Kiefe Journal: Prev Med Rep Date: 2017-01-24