The impact of a standardized disease management program on race/ethnicity and gender disparities in care and mortality.
BACKGROUND
Data on racial and gender differences in mortality in patients followed in a standardized heart failure disease management program (HFDMP) are scarce.


METHODS
Survival was calculated by race/ethnicity and gender for 837 patients enrolled in a HFDMP. (The patients studied were indigent African American and White outpatients [39% African American, 36% female] enrolled into at Leonard J. Chabert Medical Center in Houma, Louisiana.) The hazard ratio associated with demographic and clinical characteristic individually and as a whole, was estimated for the four groups.


RESULTS
White males had the highest mortality (African American female: HR=0.64, African American male: HR=0.65, White female: HR=0.67, p<.05). Age (HR=1.04, p<.001), ejection fraction (HR=0.97, p<.001), New York Heart Association (NYHA) (HR=1.57, p<.001), systolic blood pressure (HR=0.99, p<.05), hematocrit (HR=0.96, p<.01), diabetes (HR=0.98, p<.05), and body mass index (HR=0.98, p<.05) were significant predictors of mortality in the univariate model. Age (HR=1.04, p<.001), NYHA (HR=1.40, p<.001), diabetes (HR=2.52, p<.001), and White female (HR=.44, p<.01) were significant predictors of mortality in the multivariate model.


CONCLUSIONS
With the exception of White females, who demonstrated lower mortality, amongst African American males and females and White males who participated in a HFDMP no difference in survival was observed.
Hebert
Kathy
K
Div. of Cardiology, Miller School of Medicine, University of Miami, 1611 NW 12th Ave., Jackson Memorial Hospital North Wing 210, Miami, FL 33136, USA. Khebert@med.miami.edu
Lopez
Barbara
B
Horswell
Ron
R
Tamariz
Leonardo
L
Palacio
Ana
A
Li
Hua
H
Arcement
Lee M
LM
D001741:Black or African American / Q000706:statistics & numerical data*; D000553:Ambulatory Care; D019468:Disease Management; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006333:Heart Failure / Q000208:ethnology* / Q000401:mortality / Q000628:therapy; D006801:Humans; D008145:Louisiana; D008297:Male; D015999:Multivariate Analysis; D011203:Poverty; D015397:Program Evaluation; D016016:Proportional Hazards Models; D012737:Sex Factors; D015996:Survival Rate; D044465:White People / Q000706:statistics & numerical data*