Racial/ethnic disparities among Asian Americans in inpatient acute myocardial infarction mortality in the United States

Abstract

Background: Acute myocardial infarction (AMI) is a common high-risk disease with inpatient mortality of 5% nationally. But little is known about this outcome among Asian Americans (Asians), a fast growing racial/ethnic minority in the country. The objectives of the study are to obtain near-national estimates of differences in AMI inpatient mortality between minorities (including Asians) and non-Hispanic Whites and identify comorbidities and sociodemographic characteristics associated with these differences. Method: This is a retrospective analysis of 2010-2011 state inpatient discharge data from 10 states with the largest share of Asian population. We identified hospitalization with a primary diagnosis of AMI using the ICD-9 code and used self-reported race/ethnicity to identify White, Black, Hispanic, and Asian. We performed descriptive analysis of sociodemographic characteristics, medical comorbidities, type of AMI, and receipt of cardiac procedures. Next, we examined overall inpatient AMI mortality rate based on patients' race/ethnicity. We also examined the types of AMI and a receipt of invasive cardiac procedures by race/ethnicity. Lastly, we used sequential multivariate logistic regression models to study inpatient mortality for each minority group compared to Whites, adjusting for covariates. Results: Over 70% of the national Asian population resides in the 10 states. There were 496,472 hospitalizations with a primary diagnosis of AMI; 75% of all cases were Whites, 10% were Blacks, 12% were Hispanics, and 3% were Asians. Asians had a higher prevalence of cardiac comorbidities, including hypertension, diabetes, and kidney failure compared to Whites (p-value< 0.01). There were 158,623 STEMI (ST-elevation AMI), and the proportion of hospitalizations for STEMI was the highest for Asians (35.2% for Asians, 32.7% for Whites, 25.3% for Blacks, and 32.1% for Hispanics). Asians had the highest rates of inpatient AMI mortality: 7.2% for Asians, 6.3% for Whites, 5.4% for Blacks, and 5.9% for Hispanics (ANOVA p-value < 0.01). In adjusted analyses, Asians (OR = 1.11 [95% CI: 1.04-1.19]) and Hispanics (OR = 1.14 [1.09-1.19]) had a higher likelihood of inpatient mortality compared to Whites. Conclusions: Asians had a higher risk-adjusted likelihood of inpatient AMI mortality compared to Whites. Further research is needed to identify the underlying reasons for this finding to improve AMI disparities for Asians.

Examining Acute Coronary Syndrome Across Ethnicity, Sex, and Age

“…16,18 Additionally, AA patients are less likely to receive percutaneous coronary intervention, angiography, drug-eluting stents, and coronary artery bypass grafting. 12,18,21,22 Multiple explanations have been postulated; in part, this may be due to misdiagnosis of ACS owing to higher comorbidities or lack of resources resulting in slower referral for procedures, deliberate refusal of angiography interventions, 12 and limitations to access with deterrence from associated costs of seeking care. 18 Moreover, causes for the gaps in procedural rates may extend beyond health care systems and be rooted in personal motivations, including trust level, hesitancies, and preferences.…”

“…While conflicting evidence continues to be observed, remarkably, some studies have found that despite the dwindling rates of timely procedures, AA patients had lower in-hospital mortality rates compared with other underrepresented groups. 18,22 However, once discharged, AA patients report extensively more adverse symptoms resulting in more clinic visits 1 month after an ACS admission. 12,16 Consequently, repeat hospitalization rates after ACS events are significantly higher in AA patients.…”

Impact of remote delivery of clinical pharmacy services on health disparities and access to care

“…[6][7][8] Both patient-and provider-related barriers can significantly contribute to health and health care disparities, which can in turn influence patients' perceptions of care and negatively affect health outcomes, especially in vulnerable groups. Regarding patient-related barriers, racial and ethnic minority groups have higher inpatient mortality rates from severe acute respiratory failure, 9 acute myocardial infarction, 10 and sepsis than non-Hispanic Whites. 11 Sexual minorities neither see nor receive health care services as often as heterosexual patients because of factors such as perceived discrimination, prejudice, poor provider-patient experiences, lack of culturally competent providers, potential harassment in medical settings, and lack of insurance coverage.…”

Racial and Ethnic Differences in Healthcare Utilization among Medicare Fee-For-Service Enrollees

“…First, recent studies have shown poor health outcomes among Asians and we hypothesize that this may be associated with low healthcare utilization. 5 Second, continuity of care or frequent ambulatory care utilization is associated with improved healthcare outcomes and lower rates of emergency room visits. Third, the Asian population has been growing faster than the overall national population, which means that their health outcomes will have increasing significance in national healthcare outcomes.…”