Abstract 13360: Racial Differences in Hospitalization Rates of Patients Who Receive a Diagnosis of Acute Coronary Syndrome in the Emergency Department

Abstract

Introduction: Although there is literature on missed diagnoses of acute coronary syndrome (ACS) in the Emergency Department (ED), and on avoidable admissions to hospitals, no previous studies have examined racial disparities in hospitalization rates among patients who received a discharge code of ACS in the ED. Hypothesis: We hypothesized that Non-White patients are more likely to be discharged home with a diagnosis of ACS than White individuals, and that health insurance, as a mediator, drives racial disparities in these hospitalization rates. Methods: We examined 51,022,910 discharge records of ED visits in Florida, New York, and Utah in years 2008, 2011, 2014, 2016/7, using state-specific data from the Healthcare Cost and Utilization Project. We identified ED admissions for acute myocardial infarction (AMI) or unstable angina using the International Classification of Disease ninth or tenth revision diagnosis codes, excluding those with chronic coronary heart disease to examine incident events only. We used generalized estimating equation models to compare risks of being sent home across race/ethnic groups including White, Black, Hispanic, and Asian/Pacific Islander patients. We used inverse probability weighting to estimate the mediating role of health insurance status on the associations. Results: Among 235,936 patients who visited the ED and received a discharge code of ACS in the study period, the proportion discharged home was 12 % among Black patients, 6 % among White patients, 9 % among Hispanic patients, and 9 % among Asian or Pacific islander patients. In age and sex-adjusted models the incidence risk ratio (IRR) for being discharged home was 1.3 (95% CI, 1.2 - 1.3) in Black patients 1.2 (95 % CI, 1.1 - 1.3) in Hispanic patients and 1.1 (95% CI, 0.9 -1.3) in Asian or Pacific Islander patients compared with White patients. Health insurance status did not play any role as a mediator. In patients below 55 years of age, differences were magnified for all racial groups compared to White patients. Conclusions: Racial disparities exist in hospitalization of AMI at the ED, which are especially marked among younger patients. Health insurance does not explain these racial differences; other possible causes need to be investigated.