当前位置： SCI文献检索 > JOURNAL OF GENERAL INTERNAL MEDICINE期刊下所有文献 > Racial differences in the medical treatment of elderly Medicare patients with acute myocardial infarction.

Racial differences in the medical treatment of elderly Medicare patients with acute myocardial infarction.

Abstract：

OBJECTIVE:To compare the use of medications in African-American and Caucasian elderly Medicare patients hospitalized with acute myocardial infarction (AMI) in Alabama. DESIGN:Retrospective medical record review. SETTING:All acute care hospitals in Alabama. PATIENTS:All Medicare patients with a principal discharge diagnosis of AMI from June 1992 through February 1993. We excluded those patients less than 65 years of age and those of ethnicity other than African-American or Caucasian (N = 4,052). MEASUREMENTS:We first performed a crude analysis using all cases to compare by race the use of thrombolysis, beta-adrenergic blockade, and aspirin in the setting of AMI. In addition, we developed a multivariable model with receipt of therapy as the outcome and demographics, severity of illness, comorbidity, and algorithm-determined candidacy for therapy as covariates. The algorithms, developed as part of the Cooperative Cardiovascular Project, were designed to identify an "ideal" pool of candidates for each therapy. MAIN RESULTS:For all cases, 9.2% (95% confidence interval [CI] 6.8, 12.1) of African Americans received thrombolysis compared with 17.3% (95% CI 16.0, 18.6) of Caucasians. Approximately 16.4% of patients received beta-adrenergic blockade, and 45.1% received aspirin, both with no racial difference. By multivariate analysis, the adjusted odds ratio for African Americans receiving thrombolysis was 0.55 (95% CI 0.41, 0.76). The corresponding odds ratio was 1.25 (95% CI 0.99, 1.59) for beta-adrenergic blockade and 1.13 (95% CI 0.96, 1.37) for aspirin. African Americans presented later after the onset of chest pain, but the refusal rate of thrombolytic therapy did not differ. CONCLUSIONS:According to this analysis, Alabama physicians used beta-adrenergic blockade and aspirin equivalently in African Americans and Caucasians. African Americans received thrombolysis less often according to the crude analysis. The multivariable analysis suggests less use of thrombolytics, even after adjusting for several covariates including indication by clinical algorithm. However, the small number of African-American patients deemed ideal candidates for thrombolysis attenuates the precision of this finding.

journal_name

J Gen Intern Med

journal_title

Journal of general internal medicine

authors

Allison JJ,Kiefe CI,Centor RM,Box JB,Farmer RM

doi

10.1007/BF02598987

subject

Has Abstract

pub_date

1996-12-01 00:00:00

pages

736-43

issue

eissn

0884-8734

issn

1525-1497

journal_volume

pub_type

杂志文章

在线工具

Racial differences in the medical treatment of elderly Medicare patients with acute myocardial infarction.