N
Engl J Med 2000 Apr 13;342(15):1094-100
Relation of race and sex to the use of reperfusion therapy in Medicare
beneficiaries with acute myocardial infarction.
Canto JG, Allison JJ, Kiefe CI, Fincher C, Farmer R, Sekar P, Person S,
Weissman NW.
Center for Outcomes and Effectiveness Research and Education, University
of Alabama at Birmingham, 35294-0012, USA.
BACKGROUND: There are few reports describing the combined
influence of the race and sex of a patient on the use of reperfusion therapy
for acute myocardial infarction.
METHODS: To determine the relation of race and sex to
the receipt of reperfusion therapy for
myocardial infarction in the United States, we reviewed the medical records
of 234,769 Medicare patients with myocardial infarction. From these records
we identified 26,575 white or black patients who met strict eligibility
criteria for reperfusion therapy. We then performed bivariate and multivariate
analyses of prevalence ratios to determine predictors of the use of reperfusion
therapy in four subgroups of patients categorized according to race and
sex: white men, white women, black men, and black women.
RESULTS: Among eligible patients, white men received
reperfusion therapy with the highest frequency (59 percent), followed
by white women (56 percent), black men (50 percent), and black women (44
percent). After adjustment for differences in demographic and clinical
characteristics, white women were as likely as white men to receive reperfusion
therapy (prevalence ratio, 1.00; 95 percent confidenceinterval, 0.98 to
1.03). Likewise, black women were as likely as black men to receive reperfusion
therapy (prevalence ratio, 1.00; 95 percent confidence interval, 0.89
to 1.13). However, black women were significantly less likely to receive
reperfusion therapy than white men (prevalence ratio, 0.90; 95 percent
confidence interval, 0.82 to 0.98), as were black men (prevalence ratio,
0.85; 95 percent confidence interval, 0.78 to 0.93).
CONCLUSIONS: After adjustment for differences in clinical
and demographic characteristics and clinical presentation, differences
according to sex in the use of reperfusion therapy are minimal. However,
blacks, regardless of sex, are significantly less likely than whites to
receive this potentially lifesaving therapy.
PMID: 10760310 [PubMed - indexed for MEDLINE]
