title: Sex and Race/Ethnicity-Related Disparities in Care and Outcomes After Hospitalization for Coronary Artery Disease Among Older Adults.
abstract: BACKGROUND
  It is unclear to what extent cardiovascular health disparities exist and can be modified among sexes, racial/ethnic groups, and geographic regions in US hospitals.
  
  
  RESULTS
  We conducted a cohort study of 49 358 patients aged 65 years and older, admitted to 366 US hospitals from 2003 to 2009 as part of the Get With The Guidelines--Coronary Artery Disease registry linked with Medicare inpatient data. We examined mortality disparities of sex, race/ethnicity, and geographic region with 3-year mortality. The mediator was defined as receiving optimal quality of care. Logistic regression with generalized estimating equations and mediation analysis were used. Compared with men, women were less likely to receive optimal care (odds ratio=0.92; 95% confidence interval: 0.88-0.95; P<0.0001) and more likely to have higher mortality if they received suboptimal care (odds ratio=1.25; 95% confidence interval: 1.00-1.55; P=0.05, P for interaction=0.04). Approximately 69% of the sex disparity may potentially be reduced by providing optimal quality of care to women. Quality of care did not differ across racial/ethnic groups or geographic regions. Blacks were more likely to die than whites (odds ratio=1.33; 95% confidence interval: 1.21-1.46; P<0.0001), and this disparity persisted regardless of the quality of care received.
  
  
  CONCLUSIONS
  Women were less likely than men to receive optimal care at discharge. The observed sex disparity in mortality could potentially be reduced by providing equitable and optimal care. In contrast, the higher mortality observed in black patients could not be accounted for by differences in the quality of care measured in this study.
authors.affiliation: From the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (S.L.); Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.); Duke Clinical Research Institute, Durham, NC (L.L., P.J.S., A.D., A.F.H., E.D.P.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Division of Cardiology, Duke University School of Medicine, Durham, NC (A.D., A.F.H., E.D.P.); Brigham and Women's Hospital Heart & Vascular Center, and Harvard Medical School, Boston, MA (D.L.B.).
authors.forename: Shanshan
authors.initials: S
authors.lastname: Li
authors.affiliation: From the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (S.L.); Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.); Duke Clinical Research Institute, Durham, NC (L.L., P.J.S., A.D., A.F.H., E.D.P.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Division of Cardiology, Duke University School of Medicine, Durham, NC (A.D., A.F.H., E.D.P.); Brigham and Women's Hospital Heart & Vascular Center, and Harvard Medical School, Boston, MA (D.L.B.).
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: From the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (S.L.); Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.); Duke Clinical Research Institute, Durham, NC (L.L., P.J.S., A.D., A.F.H., E.D.P.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Division of Cardiology, Duke University School of Medicine, Durham, NC (A.D., A.F.H., E.D.P.); Brigham and Women's Hospital Heart & Vascular Center, and Harvard Medical School, Boston, MA (D.L.B.).
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Mukamal
authors.affiliation: From the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (S.L.); Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.); Duke Clinical Research Institute, Durham, NC (L.L., P.J.S., A.D., A.F.H., E.D.P.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Division of Cardiology, Duke University School of Medicine, Durham, NC (A.D., A.F.H., E.D.P.); Brigham and Women's Hospital Heart & Vascular Center, and Harvard Medical School, Boston, MA (D.L.B.).
authors.forename: Li
authors.initials: L
authors.lastname: Liang
authors.affiliation: From the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (S.L.); Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.); Duke Clinical Research Institute, Durham, NC (L.L., P.J.S., A.D., A.F.H., E.D.P.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Division of Cardiology, Duke University School of Medicine, Durham, NC (A.D., A.F.H., E.D.P.); Brigham and Women's Hospital Heart & Vascular Center, and Harvard Medical School, Boston, MA (D.L.B.).
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Schulte
authors.affiliation: From the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (S.L.); Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.); Duke Clinical Research Institute, Durham, NC (L.L., P.J.S., A.D., A.F.H., E.D.P.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Division of Cardiology, Duke University School of Medicine, Durham, NC (A.D., A.F.H., E.D.P.); Brigham and Women's Hospital Heart & Vascular Center, and Harvard Medical School, Boston, MA (D.L.B.).
authors.forename: Eric E
authors.initials: EE
authors.lastname: Smith
authors.affiliation: From the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (S.L.); Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.); Duke Clinical Research Institute, Durham, NC (L.L., P.J.S., A.D., A.F.H., E.D.P.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Division of Cardiology, Duke University School of Medicine, Durham, NC (A.D., A.F.H., E.D.P.); Brigham and Women's Hospital Heart & Vascular Center, and Harvard Medical School, Boston, MA (D.L.B.).
authors.forename: Adam
authors.initials: A
authors.lastname: DeVore
authors.affiliation: From the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (S.L.); Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.); Duke Clinical Research Institute, Durham, NC (L.L., P.J.S., A.D., A.F.H., E.D.P.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Division of Cardiology, Duke University School of Medicine, Durham, NC (A.D., A.F.H., E.D.P.); Brigham and Women's Hospital Heart & Vascular Center, and Harvard Medical School, Boston, MA (D.L.B.).
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: From the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (S.L.); Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.); Duke Clinical Research Institute, Durham, NC (L.L., P.J.S., A.D., A.F.H., E.D.P.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Division of Cardiology, Duke University School of Medicine, Durham, NC (A.D., A.F.H., E.D.P.); Brigham and Women's Hospital Heart & Vascular Center, and Harvard Medical School, Boston, MA (D.L.B.).
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: From the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (S.L.); Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.); Duke Clinical Research Institute, Durham, NC (L.L., P.J.S., A.D., A.F.H., E.D.P.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Division of Cardiology, Duke University School of Medicine, Durham, NC (A.D., A.F.H., E.D.P.); Brigham and Women's Hospital Heart & Vascular Center, and Harvard Medical School, Boston, MA (D.L.B.). dlbhattmd@post.harvard.edu.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D011787:Quality of Health Care; D012727:Sex Characteristics
keywords: cardiovascular disease; epidemiology; ethnic groups; mortality; sex