MI Mortality Higher for All at Hospitals With High Black-Patient Prevalence
Race aside, acute MI patients are more likely to die within 90 days of the event if they are treated at a hospital that has a disproportionately high number of black patients, researchers here reported today.
The higher death risk was observed among both black and white patients, said Jonathan Skinner, Ph.D., a professor of economics and community and family medicine at Dartmouth Medical Center here.
Dr. Skinner and colleagues analyzed data from 4,289 hospitals, and identified 541 hospitals where third or more of patients were black. At those 541 hospitals the 90-day mortality rate was 23.7% versus a 20% rate in hospitals that treated no black patients.
“That’s a 19% increase in mortality risk,” Dr. Skinner and colleagues reported in the Oct. 25 issue of Circulation, Journal of the American Heart Association.
The finding suggests that by concentrating quality improvement efforts on these 541 hospitals, “it is possible to not only significantly improve black-white disparity in heart disease treatment but also to achieve an across-the-board improvement in heart disease outcomes,” they wrote.
The study was funded in part by the National Institute on Aging (NIA), and the Robert Wood Johnson Foundation. Mark McClellan, M.D, M.P.H., Ph.D., who is administrator of the Centers for Medicare/Medicaid Services, was a co-author.
In a statement issued today, Richard Suzman, Ph.D., associate director of NIA, said that racial disparities in health care and health outcomes are well known, but this new study “sheds light on the mechanisms that may be at work in the case of hospital care and Heart attacks.”
The disparity in mortality cannot be explained by severity of illness, Dr. Skinner said, since Heart attack patients treated at hospitals where no black patients are treated were the sickest based on other comorbidities. “But those hospitals had the lowest mortality,” he said.
Dr. Skinner said that adjusting for patients’ income, type of hospital ownership—public versus private or for-profit versus not-for-profit—region of the country or urban status also did not explain the difference in mortality.
He and his colleagues analyzed Medicare data to identify 1,126,736 acute MI patients treated between 1997 and 2001.
They wrote that the most “important limitation of the present study is the possibility that the unobservable health status of acute MI patients in neighborhoods served by hospitals with a disproportionate number of black acute-MI admissions is systematically different from the average. If so, the higher mortality rates observed in these hospitals could be the result of unmeasured confounding factors, rather than hospital performance per se.”
But when mortality is figured independently for blacks and whites, a “significant gradient” is still observed.
Dr. Skinner suggested that the introduction of system-wide reforms such as strict adherence to evidence-based guidelines could improve outcomes, but a quicker fix may be to direct all patients “toward high-quality hospitals.”
Source: Circulation, Journal of the American Heart Association
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