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  • Title: Severity of illness, treatment environments, and outcomes of treating acute myocardial infarction for Hispanic Americans.
    Author: Shen JJ.
    Journal: Ethn Dis; 2002; 12(4):488-98. PubMed ID: 12477134.
    Abstract:
    OBJECTIVE: To examine associations of ethnicity with severity of illness, treatment environments, outcomes, as well as their interactions among acute myocardial infarction (AMI) patients. DESIGN, SETTING, AND PARTICIPANTS: 182,374 Hispanic and non-Hispanic White AMI discharges in the 1998-1999 National Inpatient Sample. MAIN OUTCOME MEASURES: In addition to measuring severity of illness and the treatment environments defined as care-seeking characteristics and process of care, the principal outcome measure was hospital mortality. RESULTS: Compared to non-Hispanic White patients, Hispanic patients were associated with a greater comorbidity index, less likely to be treated in small (odds ratios [OR], 0.67), rural (OR, 0.39), or low-volume hospitals (OR, 0.90), but more likely to be treated in teaching hospitals (OR, 1.74). Further, Hispanic patients were less likely to receive arteriography, PTCA, and CABG, but positively associated with more resource use; also, Hispanic patients were less likely to be discharged to non-acute health facilities (OR, 0.80) or to die in hospital (OR, 0.78). Finally, comorbidities and the receiving of PTCA interacted with ethnicity, respectively, to affect mortality. CONCLUSIONS: Substantial differences in the hospital care for AMI existed between Hispanic and non-Hispanic White patients. While the treatment environments were less favorable for Hispanics, their survival advantage over non-Hispanic Whites remains to be unexplained. Biological or other social or clinical factors need to be identified to better explain the lower mortality rates of Hispanics. Enhancing access to specialized services should improve health outcomes for non-Hispanic Whites.
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