Authors:

Abstract

Context

Prior studies have documented gender and race/ethnic disparities in outcomes after acute myocardial infarction (AMI), but the understanding of these disparities remains limited.

Objective

To evaluate, in a setting that controls for access to medical care, whether gender and race/ethnic disparities remain after consideration of socioeconomic background, personal medical history, clinical variables (including severity of index AMI) and medical management.

Design

Prospective cohort study Setting and Participants: Members (20,254 men and 10,061 women) of an integrated health care delivery system in Northern California, USA, who suffered an AMI between January 1, 1995 and December 31, 2002, followed-up for a median of 3.5 years (maximum, 8 years).

Main Outcome Measures

AMI recurrence and all-cause mortality.

Results

In age-adjusted analyses and relative to white men, black men (hazard ratio [HR] = 1.37; confidence interval [CI], 1.19 - 1.57), black women (HR = 1.49; CI, 1.28 - 1.74) and Asian women (HR = 1.41; CI, 1.16 - 1.72) were at increased risk of AMI recurrence. However, multivariate adjustment for sociodemographic background, index AMI severity, cardiovascular risk factors, comorbidities, medication use and revascularization procedures effectively removed the excess risk of AMI recurrence in these three groups. Similarly, an increased age-adjusted risk of all-cause mortality was seen in black men (HR = 1.47; CI, 1.30 - 1.67) and black women (HR = 1.36; CI, 1.18 - 1.57), which was greatly attenuated in black men and reversed in black women after full multivariate adjustment.

Conclusion

In a population with equal access to medical care, comprehensive consideration of social, personal and medical factors did explain gender and race/ethnic disparities after AMI.

Full Article from the Archives of Internal Medicine web site