title: Gender differences across racial and ethnic groups in the quality of care for acute myocardial infarction and heart failure associated with comorbidities.
abstract: This paper provides important insights on gender differences across racial and ethnic groups in a Medicare population in terms of the quality of care received for acute myocardial infarction (AMI) and congestive heart failure (CHF) in association with diabetes or hypertension/end-stage renal disease (ESRD). Both race/ethnicity and gender are associated with differences in the diagnostic evaluation and treatment of Medicare recipients with these conditions. In the AMI group, non-Hispanic Black and Hispanic patients of both genders were less likely to receive aspirin or beta-blockers than non-Hispanic Whites. These differences persisted for Hispanic women and men even when they presented with ESRD or diabetes. Rates for smoking cessation counseling were among the lowest among non-Hispanic Blacks and Hispanics with AMI-diabetes and non-Hispanic blacks with AMI-hypertension/ESRD. Gender comparisons within racial groups for the AMI and AMI-diabetes groups show that among non-Hispanic Whites, women were less likely to receive aspirin and beta-blockers. No gender differences were noted among non-Hispanic Black and Hispanic Medicare recipients. In the CHF group, Hispanics were the racial/ethnic group least likely to have an assessment of left ventricular function (LVF), even if they had diabetes and had lower rates of angiotensin-converting enzyme inhibitor therapy or even if they had combined CHF-hypertension/ESRD. Gender comparisons in both the CHF and CHF-hypertension/ESRD groups show that non-Hispanic White women were less likely to have an LVF assessment than non-Hispanic White men. Among all subjects, having comorbidities with AMI was not associated with higher markers of quality cardiovascular care. Closing the many gaps in cardiovascular care must target the specific needs of women and men across racial and ethnic groups.
authors.affiliation: Agency for Healthcare Research and Quality, Rockville, Maryland 20850, USA. Rcorrea@ahrq.gov
authors.forename: Rosaly
authors.initials: R
authors.lastname: Correa-de-Araujo
authors.forename: Beth
authors.initials: B
authors.lastname: Stevens
authors.forename: Ernest
authors.initials: E
authors.lastname: Moy
authors.forename: David
authors.initials: D
authors.lastname: Nilasena
authors.forename: Francis
authors.initials: F
authors.lastname: Chesley
authors.forename: Kelly
authors.initials: K
authors.lastname: McDermott
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D001213:Asian / Q000706:statistics & numerical data; D015897:Comorbidity; D016001:Confidence Intervals; D003920:Diabetes Mellitus / Q000208:ethnology / Q000628:therapy; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006305:Health Status Indicators; D006333:Heart Failure / Q000208:ethnology* / Q000628:therapy*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000208:ethnology / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000628:therapy; D008297:Male; D006278:Medicare / Q000592:standards*; D009203:Myocardial Infarction / Q000208:ethnology* / Q000628:therapy*; D016017:Odds Ratio; D011159:Population Surveillance; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D014932:Women's Health Services / Q000592:standards*