Do Gender and Race/Ethnicity Influence Acute Myocardial Infarction Quality of Care in a Hospital with a Large Hispanic Patient and Provider Representation?
Background. Disparities in acute myocardial infarction (AMI) care for women and minorities have been extensively reported in United States but with limited information on Hispanics. Methods. Medical records of 287 (62%) Hispanic and 176 (38%) non-Hispanic white (NHW) patients and 245 women (53%) admitted with suspected AMI to a southern California nonprofit community hospital with a large Hispanic patient and provider representation were reviewed. Baseline characteristics, outcomes (mortality, CATH, PCI, CABG, and use of pertinent drug therapy), and medical insurance were analyzed according to gender, Hispanic and NHW race/ethnicity when AMI was confirmed. For categorical variables, chi-square analysis was conducted. Odds ratio and 95% confidence interval for outcomes adjusted for gender, race/ethnicity, cardiovascular risk factors, and insurance were obtained. Results. Women and Hispanics had similar drug therapy, CATH, PCI, and mortality as men and NHW when AMI was confirmed ( ). Hispanics had less private insurance than NHW (31.4% versus 56.3%, ); no significant differences were found according to gender. Conclusions. No differences in quality measures and outcomes were found for women and between Hispanic and NHW in AMI patients admitted to a facility with a large Hispanic representation. Disparities in medical insurance showed no influence on these findings. 1. Introduction Gender and race/ethnic disparities have been often reported in United States with women and minority groups receiving less cardiac catheterization (CATH), thrombolytic therapy, percutaneous coronary interventions (PCI), coronary artery bypass graft (CABG) surgery, aspirin (ASA), beta-blockers, angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB), statins, and referral to cardiac rehabilitation than men and Whites. These disparities have been documented extensively in women and African-Americans [1–13] but a paucity of current information exists in Hispanics, who have been frequently underrepresented in the pertinent literature. In general, most of the information in Hispanics has either been obtained more than 10 years ago [6, 14–16] and/or from hospitals with a proportionally very limited Hispanic patient representation (not beyond 1–5% of the data base analyzed) [6, 15–17]. In health care the interaction of socioeconomic factors with the cultural characteristics of patients and providers has a universally recognized importance [18, 19]. The objective of the present study is to provide insights in this issue analyzing the experience of a hospital
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