Sex and racial/ethnic disparities in outcomes after acute myocardial infarction: a cohort study among members of a large integrated health care delivery system in northern California.
BACKGROUND
Previous studies have documented sex and racial/ethnic disparities in outcomes after acute myocardial infarction (AMI), but the explanation of these disparities remains limited. In a setting that controls for access to medical care, we evaluated whether sex and racial/ethnic disparities in prognosis after AMI persist after consideration of socioeconomic background, personal medical history, and medical management.


METHODS
We conducted a prospective cohort study of the members (20,263 men and 10,061 women) of an integrated health care delivery system in northern California who had experienced an AMI between January 1, 1995, and December 31, 2002, and were followed up for a median of 3.5 years (maximum, 8 years). Main outcome measures included AMI recurrence and all-cause mortality.


RESULTS
In age-adjusted analyses relative to white men, black men (hazard ratio [HR], 1.44; 95% confidence interval [CI], 1.26-1.65), black women (HR, 1.47; 95% CI, 1.26-1.72), and Asian women (HR, 1.37; 95% CI, 1.13-1.65) were at increased risk of AMI recurrence. However, multivariate adjustment for sociodemographic background, comorbidities, medication use, angiography, and revascularization procedures effectively removed the excess risk of AMI recurrence in these 3 groups. Similarly, the increased age-adjusted risk of all-cause mortality seen in black men (HR, 1.55; 95% CI, 1.37-1.75) and black women (HR, 1.45; 95% CI, 1.27-1.66) was greatly attenuated in black men and reversed in black women after full multivariate adjustment.


CONCLUSIONS
In a population with equal access to medical care, comprehensive consideration of social, personal, and medical factors could explain sex and racial/ethnic disparities in prognosis after AMI.
Iribarren
Carlos
C
Kaiser Permanente Division of Research, Oakland, CA 94612, USA. cgi@dor.kaiser.org
Tolstykh
Irina
I
Somkin
Carol P
CP
Ackerson
Lynn M
LM
Brown
Timothy T
TT
Scheffler
Richard
R
Syme
Leonard
L
Kawachi
Ichiro
I
D000328:Adult; D000367:Age Factors; D000368:Aged; D002140:California / Q000208:ethnology; D015331:Cohort Studies; D019033:Delivery of Health Care, Integrated; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology* / Q000628:therapy; D011446:Prospective Studies; D044469:Racial Groups / Q000208:ethnology* / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors