The 130th Annual Meeting of APHA

Abstract #47110

Arlene S. Ash, PhD¹, Karen M. Freund, MD, MPH¹, Andrew C. Yacht, MD¹, Christine Chaisson, MPH², Jeong Min Lee, MD¹, and Lindsey Bramwell, RN, MPH³. (1) Dept. of Medicine, Section of General Internal Medicine, Boston University School of Medicine, 720 Harrison Ave., Suite 1108, Boston, MA 02118, 617-638-8030, aash@bu.edu, (2) Data Coordinating Center, School of Public Health, Boston University, 715 Albany Street, 4T East, Boston, MA 02118, (3) Centers for Medicare & Medicaid Services, 7500 Security Boulevard, S3-22-14, Baltimore, MD 21244-1850

Background: Studies have documented long-standing gender and racial disparities in acute myocardial infarction (AMI) diagnosis and treatment. Do gender/race disparities in recognizing coronary heart disease (CHD) persist today? Methods: We studied 306,175 1999 Medicare AMI admissions, capturing (during the 365 preceding days) demographics and diagnoses, and the presence of 5 ‘marker’ conditions that may mimic myocardial ischemia (pulmonary, digestive, chest pain, non-CHD-heart and general symptoms). Results: CHD diagnoses in the pre-AMI year were relatively uncommon for both men (38%) and women (34%), though more common (~50%) within marker-condition cohorts. Marker conditions were more prevalent for women and blacks than for white men. However, within marker-condition cohorts, women and blacks received CHD diagnoses less often than men or whites. Controlling for comorbidity and age differences increased estimated deficits in CHD identification. Compared to white men, odds ratios across the 5 cohorts range from 0.71 to 0.78 for white women, from 0.59 to 0.62 for black men, and from 0.52 to 0.57 for black women. Conclusions: Women and blacks were less likely than men and whites to receive a CHD diagnosis in the year prior to AMI admission, despite age and comorbidity profiles that typically make such diagnoses more likely. Women and black men with marker conditions may be less likely to have cardiac causes explored, thereby delaying CHD evaluation and treatment. These differences persist despite a decade of broadly disseminated findings regarding gender/race disparities in cardiac care. The database used in this study is available (within confidentiality statutes) for further research.

Learning Objectives:

• Know the magnitude of differences in heart disease diagnosis by gender and race.
• Understand how sophisticated risk adjustment can be used to study outcomes in administrative data.
• Become aware of CMS's clinically-rich AMI database as a resource for future research.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.