title: Severity of illness, treatment environments, and outcomes of treating acute myocardial infarction for Hispanic Americans.
abstract: OBJECTIVE
  To examine associations of ethnicity with severity of illness, treatment environments, outcomes, as well as their interactions among acute myocardial infarction (AMI) patients.
  
  
  METHODS
  182,374 Hispanic and non-Hispanic White AMI discharges in the 1998-1999 National Inpatient Sample.
  
  
  METHODS
  In addition to measuring severity of illness and the treatment environments defined as care-seeking characteristics and process of care, the principal outcome measure was hospital mortality.
  
  
  RESULTS
  Compared to non-Hispanic White patients, Hispanic patients were associated with a greater comorbidity index, less likely to be treated in small (odds ratios [OR], 0.67), rural (OR, 0.39), or low-volume hospitals (OR, 0.90), but more likely to be treated in teaching hospitals (OR, 1.74). Further, Hispanic patients were less likely to receive arteriography, PTCA, and CABG, but positively associated with more resource use; also, Hispanic patients were less likely to be discharged to non-acute health facilities (OR, 0.80) or to die in hospital (OR, 0.78). Finally, comorbidities and the receiving of PTCA interacted with ethnicity, respectively, to affect mortality.
  
  
  CONCLUSIONS
  Substantial differences in the hospital care for AMI existed between Hispanic and non-Hispanic White patients. While the treatment environments were less favorable for Hispanics, their survival advantage over non-Hispanic Whites remains to be unexplained. Biological or other social or clinical factors need to be identified to better explain the lower mortality rates of Hispanics. Enhancing access to specialized services should improve health outcomes for non-Hispanic Whites.
authors.affiliation: Health Administration Program, College of Health Professions, Governors State University, University Park, Illinois 60466, USA. j-shen@govst.edu
authors.forename: Jay J
authors.initials: JJ
authors.lastname: Shen
mesh_terms: D000368:Aged; D015897:Comorbidity; D003710:Demography; D005260:Female; D006630:Hispanic or Latino; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000145:classification / Q000150:complications / Q000208:ethnology* / Q000628:therapy*; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology