|Heart Attack Death Rates Found Higher for All
Patients in Hospitals Treating Larger Share of African Americans
Ninety days after acute myocardial infarction (AMI) — or heart
attack — death rates for African Americans and white patients
were found to be significantly higher in hospitals that disproportionately
serve African-American patients than in hospitals that serve mainly
white patients, according to a major new study led by researchers
at Dartmouth Medical School. The researchers suggest that quality
of care, more than racial differences per se, determines AMI outcomes.
Based on the study findings, the investigators assert that targeted
quality improvements at hospitals serving large shares of African
Americans could enhance AMI care for all patients in those hospitals
as well as potentially reduce black-white differences in AMI outcomes
The analysis, published in the October 25, 2005, edition of Circulation:
Journal of the American Heart Association, is one of the first
to look at the association between the racial composition of a
hospital’s patients and health outcomes. The study was funded in
part by the National Institute on Aging (NIA), a component of the
National Institutes of Health, U.S. Department of Health and Human
Services. Additional funding was provided by the Robert Wood Johnson
“We know that disparities exist in the health and health care
of African Americans and whites,” explains Richard Suzman, Ph.D.,
Associate Director of the NIA for Behavioral and Social Research. “Some
researchers focus on doctor-patient interactions as the major factor,
while others give more weight to hospital quality. Potential remedies
are quite different, depending on which set of factors predominates.
This study sheds light on the mechanisms that may be at work in
the case of hospital care and heart attacks.”
Led by Jonathan Skinner, Ph.D., of Dartmouth Medical School, the
research team analyzed the records of nearly all fee-for-service
Medicare patients who were treated for AMI at U.S. hospitals between
January 1, 1997, and September 30, 2001. More than 1.13 million
older adults treated at 4,289 non-Federal hospitals were included
in the study.
“Our research is consistent with the view that African Americans
tend to go to hospitals where everyone gets lower quality care,” Dr.
Skinner says. “Targeting quality improvements for all patients
at hospitals that disproportionately serve African Americans can
improve overall survival, but also deliver an extra dividend by
helping to shrink health disparities at the national level.”
Skinner and colleagues classified hospitals that treated Medicare
beneficiaries with AMI into 10 groups, depending on the extent
to which they served African Americans. The 10 hospital groups
ranged from those that admitted no African-American AMI patients
to those where more than one-third (33.6 percent) of AMI patients
were African American.
After adjusting for age, race, sex, and concurrent health problems
such as diabetes, the risk-adjusted 90-day mortality after AMI
was 20.1 percent in hospitals serving no African Americans and
23.7 percent in hospitals with the greatest share of black AMI
patients — a 19 percent higher rate. Heart attack patients treated
at largely minority-serving hospitals were not sicker and did not
have more severe heart attacks than patients at other hospitals,
the study showed. In fact, the data show that AMI patients treated
in hospitals with no African-American AMI patients were the sickest,
as measured by an index of comorbidities, but had the lowest risk-adjusted
The differences in risk-adjusted hospital mortality outcomes also
were not explained by patients’ income, type of hospital ownership,
the hospitals’ annual AMI patient volume, region of the country,
or urban status.
“We suspected that these differences could have been caused by
the higher rates of poverty among the elderly African-American
population, but this was not the case,” Skinner notes. Moreover,
he notes, the differences could not be attributed to the likelihood
of the hospital providing certain post-AMI surgical interventions,
such as coronary artery bypass grafting.
The researchers point out that in this study, 21 percent of the
hospitals treated 69 percent of the elderly African-American AMI
patients. The average Medicare AMI patient was treated in a hospital
where 6.9 percent of AMI patients were African American. Relative
to the hospital where the average AMI patient was treated, hospitals
that disproportionately treated African Americans were more likely
to be teaching facilities, more likely to be government-run (non-Federal),
and less likely to be not-for-profit.
The researchers further suggest that, because many African-American
Medicare beneficiaries live in urban areas with more than one hospital,
disparities might be reduced by directing patients toward hospitals
known to provide high-quality care.
To contact Dr. Richard Suzman: Call Susan Farrer or Vicky Cahan,
NIA Office of Communications and Public Liaison, 301-496-1752.
To contact Dr. Jonathan Skinner: Call Deborah Kimbell, Media Relations,
Dartmouth Medical School, 603-653-1913.
The NIA is the lead federal agency conducting and supporting basic,
biomedical, and behavioral and social research on aging and the
special needs and problems of older people. For more information
on research and age-related health issues, visit the NIA website
at www.nia.nih.gov or call
toll free 1-800-438-4380.
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and
Centers and is a component of the U. S. Department of Health
and Human Services. It is the primary Federal agency for conducting
and supporting basic, clinical, and translational medical research,
and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and
its programs, visit http://www.nih.gov.