Disparities by race, ethnicity, and sex in treating acute coronary syndromes.
BACKGROUND
Disparities in the management of coronary artery disease were consistently documented in blacks and women in the 1980s and 1990s. Our objective was to determine if racial/ethnic and sex differences in the use of coronary revascularization persist in a more recent cohort.


METHODS
We examined all 20,604 Medicare beneficiaries admitted for acute coronary syndrome in 2001 from a random sample of 750,000 enrollees that was oversampled for black and Hispanic subjects to assess any cardiac revascularization.


RESULTS
After controlling for demographics and comorbidities, black men and women (odds ratios [OR] 0.47, 0.40), Hispanic men and women (ORs 0.61, 0.52), and white women (OR 0.67) had lower rates of revascularization compared with white men. Lower revascularization rates persisted for white women (OR 0.67) and black men and women (OR 0.55 and 0.54), controlling for income status and geographic variation, but were no longer present in the Hispanic population.


CONCLUSIONS
The mechanisms by which disparities operate may differ for Hispanic and black populations.
Evans Department of Medicine, Boston University Medical Center, Boston, MA 02118, USA. karen.freund@bmc.org
Karen M
KM
Freund
Alice K
AK
Jacobs
Julie A
JA
Pechacek
Hilary F
HF
White
Arlene S
AS
Ash
D054058:Acute Coronary Syndrome / Q000628:therapy*; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D017678:Sex Distribution; D015607:Stents; D014481:United States; D044465:White People / Q000706:statistics & numerical data*