Shanshan Li1, Gregg C Fonarow1, Kenneth J Mukamal1, Li Liang1, Phillip J Schulte1, Eric E Smith1, Adam DeVore1, Adrian F Hernandez1, Eric D Peterson1, Deepak L Bhatt2. 1. From the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (S.L.); Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.); Duke Clinical Research Institute, Durham, NC (L.L., P.J.S., A.D., A.F.H., E.D.P.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Division of Cardiology, Duke University School of Medicine, Durham, NC (A.D., A.F.H., E.D.P.); Brigham and Women's Hospital Heart & Vascular Center, and Harvard Medical School, Boston, MA (D.L.B.). 2. From the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (S.L.); Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.); Duke Clinical Research Institute, Durham, NC (L.L., P.J.S., A.D., A.F.H., E.D.P.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Division of Cardiology, Duke University School of Medicine, Durham, NC (A.D., A.F.H., E.D.P.); Brigham and Women's Hospital Heart & Vascular Center, and Harvard Medical School, Boston, MA (D.L.B.). dlbhattmd@post.harvard.edu.
Abstract
BACKGROUND: It is unclear to what extent cardiovascular health disparities exist and can be modified among sexes, racial/ethnic groups, and geographic regions in US hospitals. METHODS AND RESULTS: We conducted a cohort study of 49 358 patients aged 65 years and older, admitted to 366 US hospitals from 2003 to 2009 as part of the Get With The Guidelines--Coronary Artery Disease registry linked with Medicare inpatient data. We examined mortality disparities of sex, race/ethnicity, and geographic region with 3-year mortality. The mediator was defined as receiving optimal quality of care. Logistic regression with generalized estimating equations and mediation analysis were used. Compared with men, women were less likely to receive optimal care (odds ratio=0.92; 95% confidence interval: 0.88-0.95; P<0.0001) and more likely to have higher mortality if they received suboptimal care (odds ratio=1.25; 95% confidence interval: 1.00-1.55; P=0.05, P for interaction=0.04). Approximately 69% of the sex disparity may potentially be reduced by providing optimal quality of care to women. Quality of care did not differ across racial/ethnic groups or geographic regions. Blacks were more likely to die than whites (odds ratio=1.33; 95% confidence interval: 1.21-1.46; P<0.0001), and this disparity persisted regardless of the quality of care received. CONCLUSIONS: Women were less likely than men to receive optimal care at discharge. The observed sex disparity in mortality could potentially be reduced by providing equitable and optimal care. In contrast, the higher mortality observed in black patients could not be accounted for by differences in the quality of care measured in this study.
BACKGROUND: It is unclear to what extent cardiovascular health disparities exist and can be modified among sexes, racial/ethnic groups, and geographic regions in US hospitals. METHODS AND RESULTS: We conducted a cohort study of 49 358 patients aged 65 years and older, admitted to 366 US hospitals from 2003 to 2009 as part of the Get With The Guidelines--Coronary Artery Disease registry linked with Medicare inpatient data. We examined mortality disparities of sex, race/ethnicity, and geographic region with 3-year mortality. The mediator was defined as receiving optimal quality of care. Logistic regression with generalized estimating equations and mediation analysis were used. Compared with men, women were less likely to receive optimal care (odds ratio=0.92; 95% confidence interval: 0.88-0.95; P<0.0001) and more likely to have higher mortality if they received suboptimal care (odds ratio=1.25; 95% confidence interval: 1.00-1.55; P=0.05, P for interaction=0.04). Approximately 69% of the sex disparity may potentially be reduced by providing optimal quality of care to women. Quality of care did not differ across racial/ethnic groups or geographic regions. Blacks were more likely to die than whites (odds ratio=1.33; 95% confidence interval: 1.21-1.46; P<0.0001), and this disparity persisted regardless of the quality of care received. CONCLUSIONS:Women were less likely than men to receive optimal care at discharge. The observed sex disparity in mortality could potentially be reduced by providing equitable and optimal care. In contrast, the higher mortality observed in black patients could not be accounted for by differences in the quality of care measured in this study.
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