title: Population-level differences in revascularization treatment and outcomes among various United States subpopulations.
abstract: Despite recent general improvements in health care, significant disparities persist in the cardiovascular care of women and racial/ethnic minorities. This is true even when income, education level, and site of care are taken into consideration. Possible explanations for these disparities include socioeconomic considerations, elements of discrimination and racism that affect socioeconomic status, and access to adequate medical care. Coronary revascularization has become the accepted and recommended treatment for myocardial infarction (MI) today and is one of the most common major medical interventions in the United States, with more than 1 million procedures each year. This review discusses recent data on disparities in co-morbidities and presentation symptoms, care and access to medical resources, and outcomes in revascularization as treatment for acute coronary syndrome, looking especially at women and minority populations in the United States. The data show that revascularization is used less in both female and minority patients. We summarize recent data on disparities in co-morbidities and presentation symptoms related to MI; access to care, medical resources, and treatments; and outcomes in women, blacks, and Hispanics. The picture is complicated among the last group by the many Hispanic/Latino subgroups in the United States. Some differences in outcomes are partially explained by presentation symptoms and co-morbidities and external conditions such as local hospital capacity. Of particular note is the striking differential in both presentation co-morbidities and mortality rates seen in women, compared to men, especially in women ≤ 55 years of age. Surveillance data on other groups in the United States such as American Indians/Alaska Natives and the many Asian subpopulations show disparities in risk factors and co-morbidities, but revascularization as treatment for MI in these populations has not been adequately studied. Significant research is required to understand the extent of disparities in treatment in these subpopulations.
authors.affiliation: Garth Graham, Yang-Yu Karen Xiao, Dan Rappoport, University of Connecticut School of Medicine, Farmington, CT 06030, United States.
authors.forename: Garth
authors.initials: G
authors.lastname: Graham
authors.affiliation: Garth Graham, Yang-Yu Karen Xiao, Dan Rappoport, University of Connecticut School of Medicine, Farmington, CT 06030, United States.
authors.forename: Yang-Yu Karen
authors.initials: YY
authors.lastname: Xiao
authors.affiliation: Garth Graham, Yang-Yu Karen Xiao, Dan Rappoport, University of Connecticut School of Medicine, Farmington, CT 06030, United States.
authors.forename: Dan
authors.initials: D
authors.lastname: Rappoport
authors.affiliation: Garth Graham, Yang-Yu Karen Xiao, Dan Rappoport, University of Connecticut School of Medicine, Farmington, CT 06030, United States.
authors.forename: Saima
authors.initials: S
authors.lastname: Siddiqi
keywords: Cardiovascular; Disparities; Minorities; Myocardial infarction; Revascularization
references.citation: Am J Public Health. 2014 Sep;104(9):1742-50
references.pmid: 24028268
references.citation: Eur Heart J Acute Cardiovasc Care. 2016 Feb;5(1):43-54
references.pmid: 25681487
references.citation: Am J Cardiol. 2014 Feb 1;113(3):413-7
references.pmid: 24295550
references.citation: Arch Cardiol Mex. 2012 Jan-Mar;82(1):14-21
references.pmid: 22452861
references.citation: CMAJ. 2014 Apr 15;186(7):497-504
references.pmid: 24638026
references.citation: Acad Emerg Med. 2013 Jul;20(7):680-8
references.pmid: 23859581
references.citation: JAMA. 2007 Jun 13;297(22):2489-95
references.pmid: 17565083
references.citation: Diabetol Metab Syndr. 2014 Nov 05;6(1):117
references.pmid: 25419242
references.citation: J Womens Health (Larchmt). 2014 Jan;23(1):10-7
references.pmid: 24206026
references.citation: J Invasive Cardiol. 2013 Mar;25(3):114-7
references.pmid: 23468438
references.citation: Heart. 2009 Jun;95(11):895-9
references.pmid: 19147625
references.citation: Circ Cardiovasc Qual Outcomes. 2011 Jul;4(4):467-76
references.pmid: 21772003
references.citation: Heart. 2015 Mar;101(5):349-55
references.pmid: 25510395
references.citation: Lancet. 2013 Feb 23;381(9867):629-38
references.pmid: 23439102
references.citation: Am Heart J. 2006 Mar;151(3):589-97
references.pmid: 16504619
references.citation: Circulation. 2014 Feb 18;129(7):754-63
references.pmid: 24326988
references.citation: BMC Public Health. 2014 Jul 09;14:705
references.pmid: 25011538
references.citation: PLoS One. 2013 Jul 16;8(7):e69855
references.pmid: 23875005
references.citation: P R Health Sci J. 2013 Sep;32(3):138-45
references.pmid: 24133895
references.citation: Circulation. 2014 Aug 26;130(9):757-67
references.pmid: 25052403
references.citation: J Womens Health (Larchmt). 2005 Mar;14(2):117-27
references.pmid: 15775729
references.citation: BMC Med. 2014 Oct 24;12:190
references.pmid: 25341547
references.citation: Circulation. 2014 Feb 4;129(5):570-9
references.pmid: 24192801
references.citation: J Am Heart Assoc. 2014 Jul 28;3(4):null
references.pmid: 25074696
references.citation: BMJ. 2015 Jan 21;350:g7873
references.pmid: 25609052
references.citation: J Am Coll Cardiol. 2007 Nov 27;50(22):2128-32
references.pmid: 18036449
references.citation: Am J Cardiol. 2012 Nov 1;110(9):1256-61
references.pmid: 22840346
references.citation: J Am Coll Cardiol. 2012 Nov 13;60(20):2017-31
references.pmid: 23083784
references.citation: Circulation. 2012 Oct 30;126(18):2190-9
references.pmid: 22988009
references.citation: Am Heart J. 2013 Jun;165(6):893-901.e2
references.pmid: 23708159
references.citation: Am Heart J. 2012 May;163(5):741-746.e2
references.pmid: 22607849
references.citation: Circulation. 2014 Jun 17;129(24):2528-38
references.pmid: 24727094
references.citation: Am J Cardiol. 2012 Apr 15;109(8):1097-103
references.pmid: 22245410
references.citation: PLoS One. 2014 Apr 21;9(4):e95631
references.pmid: 24752383
references.citation: Am J Cardiol. 2015 Jan 1;115(1):21-6
references.pmid: 25456865
references.citation: JAMA. 2012 Nov 7;308(17):1775-84
references.pmid: 23117778
references.citation: PLoS One. 2014 Jan 15;9(1):e80973
references.pmid: 24454685
references.citation: Am J Med. 2012 Oct;125(10):1000-9
references.pmid: 22748404
references.citation: Am J Med. 2014 May;127(5):436-42
references.pmid: 24524993
references.citation: Prog Cardiovasc Dis. 2014 Nov-Dec;57(3):253-61
references.pmid: 25212986
references.citation: Heart. 2014 Sep 15;100(18):1436-43
references.pmid: 24914061
references.citation: Circulation. 2014 Jan 21;129(3):e28-e292
references.pmid: 24352519
references.citation: BMC Cardiovasc Disord. 2014 Jun 02;14:71
references.pmid: 24893930
references.citation: Curr Cardiol Rep. 2014;16(10):530
references.pmid: 25135343
references.citation: Med Care. 2011 Jul;49(7):662-7
references.pmid: 21677592
references.citation: J Am Coll Cardiol. 2012 Feb 7;59(6):630-1
references.pmid: 22300700
references.citation: Catheter Cardiovasc Interv. 2013 Sep 1;82(3):387-93
references.pmid: 23361975
references.citation: J Cardiothorac Vasc Anesth. 2014 Jun;28(3):595-600
references.pmid: 24139457
references.citation: Cardiorenal Med. 2014 Apr;4(1):1-11
references.pmid: 24847329
references.citation: JAMA. 2011 May 4;305(17):1769-76
references.pmid: 21540420
references.citation: Circulation. 2005 Mar 15;111(10):1217-24
references.pmid: 15769761
references.citation: Circulation. 2011 Dec 6;124(23):e574-651
references.pmid: 22064601
references.citation: Circulation. 2005 Mar 15;111(10):1225-32
references.pmid: 15769762
references.citation: Br J Med Med Res. 2013 Oct;3(4):1248-1257
references.pmid: 24611133
references.citation: JAMA Intern Med. 2013 Nov 11;173(20):1863-71
references.pmid: 24043208
references.citation: J Am Heart Assoc. 2014 Sep 23;3(5):e001197
references.pmid: 25249298
references.citation: Curr Cardiol Rev. 2015;11(3):238-45
references.pmid: 25418513
references.citation: Am J Cardiol. 2013 Jul 15;112(2):143-9
references.pmid: 23628307
references.citation: Circ Cardiovasc Qual Outcomes. 2013 Jul;6(4):429-35
references.pmid: 23819957
references.citation: JAMA Surg. 2014 Mar;149(3):223-7
references.pmid: 24402245
references.citation: J Cardiovasc Nurs. 2011 Jul-Aug;26(4):305-11
references.pmid: 21330929
references.citation: Am J Public Health. 2000 Jul;90(7):1128-34
references.pmid: 10897193
references.citation: Int J Gen Med. 2014 Aug 07;7:393-400
references.pmid: 25143752
references.citation: J Natl Med Assoc. 2009 Nov;101(11):1132-9
references.pmid: 19998642
references.citation: Catheter Cardiovasc Interv. 2008 Jul 1;72(1):36-44
references.pmid: 18383170
references.citation: Am J Public Health. 2012 May;102(5):936-44
references.pmid: 22420803
references.citation: Circulation. 2012 Apr 10;125(14):1748-56, S1-11
references.pmid: 22399535
references.citation: Eur Heart J Acute Cardiovasc Care. 2013 Dec;2(4):334-41
references.pmid: 24338292
references.citation: Clin Cardiol. 2013 Dec;36(12):749-56
references.pmid: 24085713
references.citation: Circ Cardiovasc Qual Outcomes. 2010 Mar;3(2):120-7
references.pmid: 20147489
references.citation: Am J Cardiol. 2013 Mar 15;111(6):781-5
references.pmid: 23273531
references.citation: Med Care Res Rev. 2007 Oct;64(5 Suppl):29S-100S
references.pmid: 17881625
references.citation: J Womens Health (Larchmt). 2013 Aug;22(8):659-66
references.pmid: 23841468
references.citation: JAMA. 2014 Nov 19;312(19):1999-2007
references.pmid: 25399275
references.citation: N Engl J Med. 2001 May 10;344(19):1443-9
references.pmid: 11346810
references.citation: Circulation. 2015 Feb 17;131(7):614-23
references.pmid: 25679303
references.citation: JAMA. 2012 Feb 22;307(8):813-22
references.pmid: 22357832
references.citation: J Womens Health (Larchmt). 2013 Sep;22(9):724-32
references.pmid: 23992103
references.citation: J Am Coll Cardiol. 2014 Dec 16;64(23):2486-94
references.pmid: 25500233
references.citation: Cochrane Database Syst Rev. 2015 Mar 10;(3):CD002229
references.pmid: 25754617
references.citation: J Am Heart Assoc. 2015 Feb 09;4(2):null
references.pmid: 25666368
references.citation: Circ Cardiovasc Qual Outcomes. 2010 Nov;3(6):684-93
references.pmid: 21081748
references.citation: Mayo Clin Proc. 2008 Jun;83(6):663-9
references.pmid: 18533083
references.citation: Am Heart J. 2007 Feb;153(2):313-9
references.pmid: 17239695
references.citation: Hippokratia. 2008 Jan;12(1):3-10
references.pmid: 18923757
references.citation: J Womens Health (Larchmt). 2013 Dec;22(12):1009-15
references.pmid: 24180299
references.citation: J Interv Cardiol. 2013 Feb;26(1):43-8
references.pmid: 23330830
references.citation: N Engl J Med. 2014 Dec 11;371(24):2298-308
references.pmid: 25494269
references.citation: JAMA. 2013 Oct 2;310(13):1353-68
references.pmid: 24084921
references.citation: Med Care Res Rev. 2013 Jun;70(3):287-309
references.pmid: 23269575
references.citation: Am J Cardiol. 2013 Nov 1;112(9):1298-305
references.pmid: 23910429
references.citation: Int J Cardiol. 2013 Oct 9;168(4):3683-90
references.pmid: 23838593
references.citation: Heart Lung Circ. 2013 Oct;22(10):861-9
references.pmid: 23628331
references.citation: Int J Cardiol. 2014 Oct 20;176(3):724-30
references.pmid: 25183535
references.citation: Am J Obstet Gynecol. 2014 Mar;210(3):210.e1-5
references.pmid: 24246525
references.citation: PLoS One. 2012;7(10):e47420
references.pmid: 23112814
references.citation: Arch Intern Med. 2003 Feb 24;163(4):461-6
references.pmid: 12588206
references.citation: Catheter Cardiovasc Interv. 2015 Feb 15;85(3):359-68
references.pmid: 25115966
references.citation: J Immigr Minor Health. 2011 Feb;13(1):61-8
references.pmid: 19466546
references.citation: JAMA. 2004 Oct 6;292(13):1563-72
references.pmid: 15467058
references.citation: J Am Coll Cardiol. 2014 Jul 29;64(4):337-45
references.pmid: 25060366
references.citation: N Engl J Med. 2012 Jun 14;366(24):2257-66
references.pmid: 22693997
references.citation: BMC Cardiovasc Disord. 2011 May 27;11:24
references.pmid: 21619566
references.citation: Heart Lung. 2014 Jul-Aug;43(4):270-7
references.pmid: 24992880
references.citation: J Am Coll Cardiol. 2014 Jun 17;63(23):2624-41
references.pmid: 24651052
references.citation: Circ Cardiovasc Qual Outcomes. 2010 Jan;3(1):82-92
references.pmid: 20123674
references.citation: J Am Coll Cardiol. 2004 Aug 4;44(3):503-8
references.pmid: 15358011