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Sex and Race/Ethnicity-Related Disparities in Care and Outcomes After Hospitalization for Coronary Artery Disease Among Older Adults.

Publication ,  Journal Article
Li, S; Fonarow, GC; Mukamal, KJ; Liang, L; Schulte, PJ; Smith, EE; DeVore, A; Hernandez, AF; Peterson, ED; Bhatt, DL
Published in: Circ Cardiovasc Qual Outcomes
February 2016

BACKGROUND: It is unclear to what extent cardiovascular health disparities exist and can be modified among sexes, racial/ethnic groups, and geographic regions in US hospitals. METHODS AND RESULTS: We conducted a cohort study of 49 358 patients aged 65 years and older, admitted to 366 US hospitals from 2003 to 2009 as part of the Get With The Guidelines--Coronary Artery Disease registry linked with Medicare inpatient data. We examined mortality disparities of sex, race/ethnicity, and geographic region with 3-year mortality. The mediator was defined as receiving optimal quality of care. Logistic regression with generalized estimating equations and mediation analysis were used. Compared with men, women were less likely to receive optimal care (odds ratio=0.92; 95% confidence interval: 0.88-0.95; P<0.0001) and more likely to have higher mortality if they received suboptimal care (odds ratio=1.25; 95% confidence interval: 1.00-1.55; P=0.05, P for interaction=0.04). Approximately 69% of the sex disparity may potentially be reduced by providing optimal quality of care to women. Quality of care did not differ across racial/ethnic groups or geographic regions. Blacks were more likely to die than whites (odds ratio=1.33; 95% confidence interval: 1.21-1.46; P<0.0001), and this disparity persisted regardless of the quality of care received. CONCLUSIONS: Women were less likely than men to receive optimal care at discharge. The observed sex disparity in mortality could potentially be reduced by providing equitable and optimal care. In contrast, the higher mortality observed in black patients could not be accounted for by differences in the quality of care measured in this study.

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Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

February 2016

Volume

9

Issue

2 Suppl 1

Start / End Page

S36 / S44

Location

United States

Related Subject Headings

  • Sex Characteristics
  • Quality of Health Care
  • Male
  • Logistic Models
  • Humans
  • Hospitalization
  • Healthcare Disparities
  • Female
  • Coronary Artery Disease
  • Cohort Studies
 

Citation

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Li, S., Fonarow, G. C., Mukamal, K. J., Liang, L., Schulte, P. J., Smith, E. E., … Bhatt, D. L. (2016). Sex and Race/Ethnicity-Related Disparities in Care and Outcomes After Hospitalization for Coronary Artery Disease Among Older Adults. Circ Cardiovasc Qual Outcomes, 9(2 Suppl 1), S36–S44. https://doi.org/10.1161/CIRCOUTCOMES.115.002621
Li, Shanshan, Gregg C. Fonarow, Kenneth J. Mukamal, Li Liang, Phillip J. Schulte, Eric E. Smith, Adam DeVore, Adrian F. Hernandez, Eric D. Peterson, and Deepak L. Bhatt. “Sex and Race/Ethnicity-Related Disparities in Care and Outcomes After Hospitalization for Coronary Artery Disease Among Older Adults.Circ Cardiovasc Qual Outcomes 9, no. 2 Suppl 1 (February 2016): S36–44. https://doi.org/10.1161/CIRCOUTCOMES.115.002621.
Li S, Fonarow GC, Mukamal KJ, Liang L, Schulte PJ, Smith EE, et al. Sex and Race/Ethnicity-Related Disparities in Care and Outcomes After Hospitalization for Coronary Artery Disease Among Older Adults. Circ Cardiovasc Qual Outcomes. 2016 Feb;9(2 Suppl 1):S36–44.
Li, Shanshan, et al. “Sex and Race/Ethnicity-Related Disparities in Care and Outcomes After Hospitalization for Coronary Artery Disease Among Older Adults.Circ Cardiovasc Qual Outcomes, vol. 9, no. 2 Suppl 1, Feb. 2016, pp. S36–44. Pubmed, doi:10.1161/CIRCOUTCOMES.115.002621.
Li S, Fonarow GC, Mukamal KJ, Liang L, Schulte PJ, Smith EE, DeVore A, Hernandez AF, Peterson ED, Bhatt DL. Sex and Race/Ethnicity-Related Disparities in Care and Outcomes After Hospitalization for Coronary Artery Disease Among Older Adults. Circ Cardiovasc Qual Outcomes. 2016 Feb;9(2 Suppl 1):S36–S44.

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

February 2016

Volume

9

Issue

2 Suppl 1

Start / End Page

S36 / S44

Location

United States

Related Subject Headings

  • Sex Characteristics
  • Quality of Health Care
  • Male
  • Logistic Models
  • Humans
  • Hospitalization
  • Healthcare Disparities
  • Female
  • Coronary Artery Disease
  • Cohort Studies