Abstract 19569: Racial Differences in Clinical Outcomes and Resource Utilization Associated With Acute Myocardial Infarction Hospitalizations in the United States: A Population-wide Analysis From 2011-2012

Abstract

Background and objectives: Racial-ethnic disparities in cardiovascular diseases are a major public health problem in the US. There are few recent data on racial differences in clinical outcomes and resource utilization associated with acute myocardial infarction (AMI) hospitalizations. Hypothesis: There are significant racial-ethnic differences in AMI hospitalization outcomes. Methods: We used the 2011-2012 Nationwide/National Inpatient Sample to identify primary AMI hospitalizations. Outcomes of interest included in-hospital mortality, utilization of PCI and thrombolysis, inflation adjusted charges and length of stay. Relevant ICD-9 codes were used. Racial-ethnic differences in outcomes were tested using logistic and linear regression models. Results: 228,302 AMI hospitalizations representing 1.1 million hospitalizations nationwide were included in the study. After adjusting for age, sex, HTN, DM, PCI, thrombolysis, socioeconomic status (SES) and APR-DRG mortality risk, Blacks had significantly lower (OR 0.88, 95% CI 0.81 - 0.94; <0.001) and Native Americans significantly higher (OR 1.37, 1.03 - 1.81; p=0.03) case fatality compared to Whites (Model ROC=0.88, p<0.001). Blacks were less likely (OR 0.76, 95% CI 0.72 - 0.80; p<0.001) and other races more likely (OR 1.33, 95% CI 1.23 - 1.43; p<0.001) to undergo PCI adjusted for SES. SES adjusted odds of thrombolysis were lower in Blacks (OR 0.80, 0.67 - 0.97; p<0.001) and higher in Native Americans (OR 3.78, 1.42 - 10.07; p=0.01) compared to Whites. There were significant differences in charges and LOS across races. Conclusions: Blacks hospitalized for AMI are less likely and NA more likely to die in the hospital compared to Whites. Blacks are less likely to receive reperfusion therapy compared to Whites. Future studies should investigate the mechanism of the apparent protective effect of Black race on in-hospital mortality in AMI.