Cardiovascular Health Disparities Worse For Women, African Americans

A large nationwide sample of more than 49,000 older Americans hospitalized with coronary artery disease found that disparities in mortality with respect to sex and race/ethnicity exist across the nation.

The study found women were less likely to receive optimal care at discharge compared with men and that African Americans had an elevated risk of mortality compared with white patients. However, the African American mortality disparity could not be accounted for by differences in the quality of care measured. No significant differences were observed in care or outcomes by geographic region.

The study, published in Circulation, followed patients 65 years of age and older who were admitted to 366 US hospitals from 2003 to 2009 as part of the Get With the Guidelines Coronary Artery Disease registry. The outcome tracked was 3-year all-cause mortality. Quality-of-care performance measures included aspirin within 24 hours, aspirin upon hospital discharge, beta-blocker on hospital discharge, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker for patients with low-ejection fraction on hospital discharge, smoking cessation counseling, and lipid-lowering medications.

Compared with men, women were less likely to receive optimal care (odds ratio [OR], 0.92; 95% CI: 0.88-0.95, P <.0001) and were more likely to have higher mortality if they received suboptimal care. Approximately 69% of the sex disparity may be reduced by providing optimal quality of care to women, researchers said. They also found that quality of care did not differ across racial/ethnic groups or geographic regions. Although African Americans were more likely to die than whites (OR, 1.33; 95% CI: 1.21-1.46; P <.0001), the disparity persisted regardless of the quality of care received.

Women tended to present with hypertension and heart failure at hospital admission more often than men, were less likely to receive lipid-lowering medications and in-hospital procedures than men, and were less likely than men to receive optimal care at discharge. Women had a 1.20-fold higher 3-year mortality rate than men, but the disparity was lessened after adjustment for demographic and medical characteristics. The researchers identified a significant interaction between sex and quality of care measures on mortality, however. Compared with men, women had higher odds of mortality if they received suboptimal care, and that sex disparity disappeared with optimal care.

Compared with white patients, African Americans had a higher prevalence of diabetes, hypertension, and dialysis but were similar regarding quality of care measures received. African American patients were at higher risk for mortality than white patients—a disparity that persisted regardless of the quality of care received.

The study authors noted that it is largely unknown whether and how differences in quality of care could explain or alleviate the sex mortality gap, but their results suggest that providing optimal care to cardiac patients could yield large gains in reducing sex-related disparities.

“This highlights the importance of targeting and tailoring quality of care programs on specific high-risk populations,” the authors concluded.