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Disparities/Minority Health

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Black/white disparities in time to treatment for heart attack patients depend on the admitting hospital

Black heart attack patients wait about 20 percent longer than similar white patients before receiving hospital treatment. Compared with white patients, black patients wait 7 minutes longer from hospital arrival until they receive a clot-busting drug (door-to-drug) and 19 minutes longer from arrival to the start of coronary angioplasty or bypass surgery (door-to-balloon). Hispanic and other ethnic patients also wait longer for treatment than their white counterparts, but their waiting times are more modest, according to a study supported in part by the Agency for Healthcare Research and Quality (HS10407). The study showed that these disparities in treatment depended on the specific hospital to which patients were admitted and not to differences in treatment inside the hospital.

For example, the crude difference in door-to-balloon time between black and white patients was reduced by 33 percent and between Hispanic and white patients by nearly 75 percent after accounting for differences between the hospitals in which they were treated. These results highlight the importance of improving the quality of care in hospitals in which minority groups are more likely to be treated, notes lead author Elizabeth H. Bradley, Ph.D., of the Yale University School of Medicine.

Nonetheless, holding the hospital in which care was received constant, there remained racial and ethnic disparities in door-to-drug and door-to-balloon times that were independent of measured differences in patients' characteristics, insurance status, or hospital characteristics. The remaining differences may result from unmeasured clinical characteristics, differences in patient preferences, doctor-patient communication patterns, or clinician/institutional bias, which may influence patterns of care. These findings were based on analysis of admission and treatment data on 73,032 patients in the National Registry of Myocardial Infarction who were admitted to participating hospitals for heart attack from 1999 through 2002.

See "Racial and ethnic differences in time to acute reperfusion therapy for patients hospitalized with myocardial infarction," by Dr. Bradley, Jeph Herrin, Ph.D., Yongfei Wang, M.S., and others, in the October 6, 2004, Journal of the American Medical Association 292(13), pp. 1563-1572.

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