Blacks with MI have higher mortality rates after ambulance diversion

Plenty of research has been devoted to examining disparities in outcomes for racial minorities. A new study, published in the June issue of Health Affairs, examined the role of emergency department (ED) crowding and ambulance diversion for blacks and whites experiencing MI.

Previous work has shown that racial and ethnic minorities often are poorly insured, have more comorbidities and receive poorer care compared to white counterparts. This study, led by Renee Hsia, professor in the department of emergency medicine at University of California, San Francisco, controlled for social determinants of health to focus on ED overcrowding.

Researchers examined data from the California Office of Statewide Health Planning and Development for 2001 to 2011. To determine diversion, the team examined ambulance diversion logs from local emergency medical services.

“Our findings suggest that blacks in California experience a ‘double burden’ of ED crowding: Not only are black-serving hospitals more likely to experience ambulance diversion, but black patients with acute MI also have worse mortality outcomes relative to whites when exposed to the same diversion levels,” Hsia and colleagues wrote.

Blacks had a 19 percent higher one-year mortality rate when compared to whites if the nearest ED had six to 12 hours of diversion. One-year mortality was 14 percent higher for blacks if the diversion was 12 hours or more. The disparities were larger when the nearest ED served primarily black populations.

The researchers controlled for available treatments and hospital technology, so findings suggest black MI patients might be receiving lower quality care on a systems level.

“Our findings suggest that policies that address ED crowding within the context of an interconnected healthcare system and target efforts in communities with black-serving hospitals might help reduce disparities in quality of care and health outcomes,” Hsai et al. wrote.

Such a system-level intervention—such as reducing ED overcrowding—could be one way to decrease disparities between ethnic and racial groups.