title: Race and place differences in patients hospitalized with an acute coronary syndrome: Is there double jeopardy? Findings from TRACE-CORE.
abstract: The objectives of this longitudinal study were to examine differences between whites and blacks, and across two geographical regions, in the socio-demographic, clinical, and psychosocial characteristics, hospital treatment practices, and post-discharge mortality for hospital survivors of an acute coronary syndrome (ACS). In this prospective cohort study, we performed in-person interviews and medical record abstractions for patients discharged from the hospital after an ACS at participating sites in Central Massachusetts and Central Georgia during 2011-2013. Among the 1143 whites in Central Massachusetts, 514 whites in Central Georgia, and 277 blacks in Central Georgia, we observed a gradient of socioeconomic position with whites in Central Massachusetts being the most privileged, followed by whites and then blacks from Central Georgia; similar gradients pertained to psychosocial vulnerability (e.g., 10.7%, 25.1%, and 49.1% had cognitive impairment, respectively) and to the hospital receipt of all 4 evidence-based cardiac medications (35.5%, 18.1%, and 14.4%, respectively) used in the acute management of patients hospitalized with an ACS. Multivariable adjusted odds ratios (95% confidence intervals) for the receipt of a percutaneous coronary intervention for whites and blacks in Georgia vs. whites in Massachusetts were 0.57 (0.46-0.71) and 0.40(0.30-0.52), respectively. Thirty-day and one-year mortality risks exhibited a similar gradient. The results of this contemporary clinical/epidemiologic study in a diverse patient cohort suggest that racial and geographic disparities continue to exist for patients hospitalized with an ACS.
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States.
authors.forename: David D
authors.initials: DD
authors.lastname: McManus
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.
authors.forename: Richard
authors.initials: R
authors.lastname: McManus
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States.
authors.forename: Mayra
authors.initials: M
authors.lastname: Tisminetzky
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.
authors.forename: Darleen
authors.initials: D
authors.lastname: Lessard
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States.
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
authors.affiliation: Department of Community Medicine, Mercer University School of Medicine, Macon, GA, United States.
authors.forename: David C
authors.initials: DC
authors.lastname: Parish
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.
authors.forename: Jeroan
authors.initials: J
authors.lastname: Allison
authors.affiliation: University of Colorado Denver - Anschutz Medical Campus, Denver, CO, United States.
authors.forename: Connie Ng
authors.initials: CN
authors.lastname: Hess
authors.affiliation: Duke Clinical Research Institute, Durham, NC, United States.
authors.forename: Tracy
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.
authors.forename: Catarina
authors.initials: C
authors.lastname: Kiefe
keywords: Acute coronary syndromes; Longitudinal study; Race and geographic differences