AIM: Worse outcomes for black MI patients not caused by care disparities

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Although black patients with MI have worse outcomes than white patients, the differences did not persist after adjustment for patient factors and site of care, according to a cohort study in the March 3 issue of the Annals of Internal Medicine.

John A. Spertus, MD, from the and University of Missouri-Kansas City, and colleagues examined 1,849 adults who had a heart attack--28 percent of whom were black. These patients were hospitalized at one of 10 U.S. hospitals that participated in a registry of MI care. The registry included information about patients' health and social factors, including information about death, rehospitalization, chest pain and quality of life after heart attack.

The researchers found that the black patients had higher unadjusted mortality (19.9 vs. 9.3 percent) and rehospitalization rates (45.4 vs. 40.4 percent), more angina (28 vs. 17.8 percent) and worse mean quality of life (80.6 vs. 85.9). They also found that black and white patients who had similar severity of heart and other diseases and similar social factors, such as level of education, had similar MI outcomes.

After adjustment for patient characteristics, the investigators found that black patients trended toward greater mortality (hazard ratio, 1.29), fewer rehospitalizations (hazard ratio, 0.82) and higher likelihood of angina at one year (odds ratio, 1.41), but similar quality of life (mean difference, -0.6). Adjustment for site of care further attenuated mortality differences (hazard ratio, 1.04).

The authors acknowledged that residual confounding and missing data may have introduced bias as a limitation.

Spertus and colleagues concluded that the differences in MI outcomes between black and white patients seem to be due to worse risk factors for heart disease in black patients rather than to differences in the care that patients receive. Based on their findings, the researchers said that strategies to reduce black-white differences in outcomes after MI should focus on improving MI factors in black patients.