title: Mortality after acute myocardial infarction in hospitals that disproportionately treat black patients.
abstract: BACKGROUND
  African Americans are more likely to be seen by physicians with less clinical training or to be treated at hospitals with longer average times to acute reperfusion therapies. Less is known about differences in health outcomes. This report compares risk-adjusted mortality after acute myocardial infarction (AMI) between US hospitals with high and low fractions of elderly black AMI patients.
  
  
  RESULTS
  A prospective cohort study was performed for fee-for-service Medicare patients hospitalized for AMI during 1997 to 2001 (n=1,136,736). Hospitals (n=4289) were classified into approximate deciles depending on the extent to which the hospital served the black population. Decile 1 (12.5% of AMI patients) included hospitals without any black AMI admissions during 1997 to 2001. Decile 10 (10% of AMI patients) included hospitals with the highest fraction of black AMI patients (33.6%). The main outcome measures were 90-day and 30-day mortality after AMI. Patients admitted to hospitals disproportionately serving blacks experienced no greater level of morbidities or severity of the infarction, yet hospitals in decile 10 experienced a risk-adjusted 90-day mortality rate of 23.7% (95% CI 23.2% to 24.2%) compared with 20.1% (95% CI 19.7% to 20.4%) in decile 1 hospitals. Differences in outcomes between hospitals were not explained by income, hospital ownership status, hospital volume, census region, urban status, or hospital surgical treatment intensity.
  
  
  CONCLUSIONS
  Risk-adjusted mortality after AMI is significantly higher in US hospitals that disproportionately serve blacks. A reduction in overall mortality at these hospitals could dramatically reduce black-white disparities in healthcare outcomes.
authors.affiliation: Center for Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH 03755, USA. jonathan.skinner@dartmouth.edu
authors.forename: Jonathan
authors.initials: J
authors.lastname: Skinner
authors.forename: Amitabh
authors.initials: A
authors.lastname: Chandra
authors.forename: Douglas
authors.initials: D
authors.lastname: Staiger
authors.forename: Julie
authors.initials: J
authors.lastname: Lee
authors.forename: Mark
authors.initials: M
authors.lastname: McClellan
mesh_terms: D044383:Black People; D003695:Delivery of Health Care / Q000592:standards; D017052:Hospital Mortality; D006801:Humans; D006278:Medicare; D008913:Minority Groups; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality*; D012044:Regression Analysis; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology; D001741:Black or African American