Racial differences in the medical treatment of elderly Medicare patients with acute myocardial infarction.
OBJECTIVE
To compare the use of medications in African-American and Caucasian elderly Medicare patients hospitalized with acute myocardial infarction (AMI) in Alabama.


METHODS
Retrospective medical record review.


METHODS
All acute care hospitals in Alabama.


METHODS
All Medicare patients with a principal discharge diagnosis of AMI from June 1992 through February 1993. We excluded those patients less than 65 years of age and those of ethnicity other than African-American or Caucasian (N = 4,052).


METHODS
We first performed a crude analysis using all cases to compare by race the use of thrombolysis, beta-adrenergic blockade, and aspirin in the setting of AMI. In addition, we developed a multivariable model with receipt of therapy as the outcome and demographics, severity of illness, comorbidity, and algorithm-determined candidacy for therapy as covariates. The algorithms, developed as part of the Cooperative Cardiovascular Project, were designed to identify an "ideal" pool of candidates for each therapy.


RESULTS
For all cases, 9.2% (95% confidence interval [CI] 6.8, 12.1) of African Americans received thrombolysis compared with 17.3% (95% CI 16.0, 18.6) of Caucasians. Approximately 16.4% of patients received beta-adrenergic blockade, and 45.1% received aspirin, both with no racial difference. By multivariate analysis, the adjusted odds ratio for African Americans receiving thrombolysis was 0.55 (95% CI 0.41, 0.76). The corresponding odds ratio was 1.25 (95% CI 0.99, 1.59) for beta-adrenergic blockade and 1.13 (95% CI 0.96, 1.37) for aspirin. African Americans presented later after the onset of chest pain, but the refusal rate of thrombolytic therapy did not differ.


CONCLUSIONS
According to this analysis, Alabama physicians used beta-adrenergic blockade and aspirin equivalently in African Americans and Caucasians. African Americans received thrombolysis less often according to the crude analysis. The multivariable analysis suggests less use of thrombolytics, even after adjusting for several covariates including indication by clinical algorithm. However, the small number of African-American patients deemed ideal candidates for thrombolysis attenuates the precision of this finding.
Allison
J J
JJ
Division of General Internal Medicine, University of Alabama, Birmingham School of Medicine, USA.
Kiefe
C I
CI
Centor
R M
RM
Box
J B
JB
Farmer
R M
RM
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000407:Alabama; D000465:Algorithms; D001241:Aspirin / Q000627:therapeutic use*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000191:economics / Q000208:ethnology*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D014481:United States
D000319:Adrenergic beta-Antagonists; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin