Racial/ethnic disparities among Asian Americans in inpatient acute myocardial infarction mortality in the United States. - 2018

Available online from MWHC library: 2001 - present

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. 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. 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.


English

1472-6963

10.1186/s12913-018-3180-0 [doi] 10.1186/s12913-018-3180-0 [pii] PMC5956856 [pmc]


*Health Status Disparities
*Hospitalization/sn [Statistics & Numerical Data]
*Myocardial Infarction/mo [Mortality]
Adolescent
Adult
African Americans/sn [Statistics & Numerical Data]
Age Distribution
Aged
Aged, 80 and over
Asian Americans/sn [Statistics & Numerical Data]
Diabetic Angiopathies/eh [Ethnology]
Diabetic Angiopathies/mo [Mortality]
European Continental Ancestry Group/sn [Statistics & Numerical Data]
Female
Hispanic Americans/sn [Statistics & Numerical Data]
Hospital Mortality
Humans
Hypertension/eh [Ethnology]
Hypertension/mo [Mortality]
Kidney Failure, Chronic/eh [Ethnology]
Kidney Failure, Chronic/mo [Mortality]
Logistic Models
Male
Middle Aged
Myocardial Infarction/eh [Ethnology]
Prevalence
Retrospective Studies
United States/ep [Epidemiology]
Young Adult


MedStar Washington Hospital Center


Surgery/General Surgery


Journal Article