Is geography destiny for patients in New York with myocardial infarction?
OBJECTIVE
The use of coronary revascularization among patients with myocardial infarction varies by race/ethnicity and socioeconomic status. The objective of this study was to determine whether local availability of facilities might influence apparent racial disparities in revascularization and health outcomes.


METHODS
Using Statewide Planning and Research Cooperative System data (1988-1999) from the New York State Department of Health, we determined revascularization rates among patients hospitalized with myocardial infarction in two socioeconomically disadvantaged communities in New York City (the South Bronx, which has no hospitals that have revascularization facilities, and Harlem, which has three revascularization facilities), as well as in its most advantaged community (mid-Manhattan, which has six such facilities). The rest of New York City served as reference. We measured demographic and clinical characteristics and revascularization rates in each community.


RESULTS
Among patients hospitalized with myocardial infarction, the age-adjusted revascularization rates were 29.2% for whites, 12.5% for blacks, and 19.9% for Hispanics (P <0.01). Rates were 12.0% in the South Bronx, 24.0% in Harlem, 38.4% in mid-Manhattan, and 21.2% in the rest of New York City (P <0.05). Logistic regression analysis, adjusting for age, sex, race, insurance status, comorbidity, clinical complications, and year of admission, revealed that South Bronx patients were about 20% less likely to be revascularized than those in the rest of New York City, whereas patients living in Harlem were twice as likely to receive such treatment as residents in the rest of New York City. Among patients admitted to hospitals with cardiac revascularization facilities, lower use among South Bronx residents persisted, but after adjusting for patient characteristics, Harlem residents were significantly less likely to be revascularized than those from the rest of New York City.


CONCLUSIONS
Race and socioeconomic factors influence the likelihood of revascularization after myocardial infarction among residents of New York City. In addition, lack of availability of revascularization further reduces its use by residents of disadvantaged neighborhoods.
Fang
Jing
J
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York 10461, USA. fang@aecom.yu.edu
Alderman
Michael H
MH
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000601:surgery; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D009519:New York City / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D011204:Poverty Areas; D044469:Racial Groups; D012959:Socioeconomic Factors; D044465:White People / Q000706:statistics & numerical data