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Race, not sex, limits access to life-saving therapies for heart attack patients

A new study funded by the Agency for Healthcare Research and Quality finds that black Medicare beneficiaries, regardless of sex, are significantly less likely than whites to receive reperfusion therapies, which open blocked arteries to prevent a potential heart attack. The study, conducted by researchers at the University of Alabama at Birmingham, adds to the current body of evidence on racial disparities and access to health care.

More than 1 million patients in the United States have heart attacks each year, and most of them are candidates for reperfusion therapy—either thrombolytic drugs or primary angioplasty—as recommended by the American College of Cardiology and the American Heart Association. However, the researchers found that only 57 percent of all patients who were eligible for this treatment actually received it. White men were most likely to receive the reperfusion therapies (59 percent), followed by white women (56 percent), black men (50 percent), and black women (44 percent). After careful analyses accounting for differences in age, symptoms, and results of diagnostic tests, the researchers concluded that, regardless of sex, blacks were less likely than whites to receive this potentially life-saving therapy.

According to the researchers, the reasons for the lower rate of reperfusion therapy use in blacks are not readily apparent, but they may include the preferences of the patient, the expertise and preferences of the physician, hospital barriers to treatment, or unrecognized differences in patients' symptoms associated with race. Other likely explanations are clinical ambiguity about the treatments, physicians' lack of training or insufficient knowledge, and physicians' own preferences or biases. Finally, cultural barriers may have contributed to racial disparities in the administration of these therapies. More research is warranted to explore and define these barriers, conclude the researchers.

The researchers reviewed the medical records of 234,769 Medicare beneficiaries in the United States from February 1994 to July 1995. From those records, 26,575 white and black patients met the strict eligibility criteria for reperfusion therapy. Statistical analyses of prevalence ratios determined the predictors of reperfusion use, dividing the study population into four subgroups of patients by race and sex.

The study was performed with support from two AHRQ research grants (HS08843 and HS09446) on impact of guidelines on quality of care for unstable angina and on benchmarking for quality of care, both directed by Catarina I. Kiefe, Ph.D., M.D., of the University of Alabama School of Medicine, Birmingham.

For more information on the study, see "Relation of race and sex to the use of reperfusion therapy in medicare beneficiaries with acute myocardial infarction," by John G. Canto, M.D., M.S.P.H., Jeroan J. Allison, M.D., Dr. Kiefe, and others in the April 13, 2000 New England Journal of Medicine 342(15), pp. 1094-1100.

Editor's Note: AHRQ plans to spend up to $20 million over the next 5 years to fund up to four centers of excellence to study the root causes of disparities in health care and develop strategies to eliminate them. This new program was developed to respond to the U.S. Department of Health and Human Services' Initiative on Eliminating Racial and Ethnic Disparities and a comparable goal in the U.S. Surgeon General's Healthy People 2010 program.

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