Peer-review started: May 31, 2015
First decision: August 25, 2015
Revised: October 12, 2015
Accepted: November 3, 2015
Article in press: November 4, 2015
Published online: January 26, 2016
Processing time: 237 Days and 9.9 Hours
Despite recent general improvements in health care, significant disparities persist in the cardiovascular care of women and racial/ethnic minorities. This is true even when income, education level, and site of care are taken into consideration. Possible explanations for these disparities include socioeconomic considerations, elements of discrimination and racism that affect socioeconomic status, and access to adequate medical care. Coronary revascularization has become the accepted and recommended treatment for myocardial infarction (MI) today and is one of the most common major medical interventions in the United States, with more than 1 million procedures each year. This review discusses recent data on disparities in co-morbidities and presentation symptoms, care and access to medical resources, and outcomes in revascularization as treatment for acute coronary syndrome, looking especially at women and minority populations in the United States. The data show that revascularization is used less in both female and minority patients. We summarize recent data on disparities in co-morbidities and presentation symptoms related to MI; access to care, medical resources, and treatments; and outcomes in women, blacks, and Hispanics. The picture is complicated among the last group by the many Hispanic/Latino subgroups in the United States. Some differences in outcomes are partially explained by presentation symptoms and co-morbidities and external conditions such as local hospital capacity. Of particular note is the striking differential in both presentation co-morbidities and mortality rates seen in women, compared to men, especially in women ≤ 55 years of age. Surveillance data on other groups in the United States such as American Indians/Alaska Natives and the many Asian subpopulations show disparities in risk factors and co-morbidities, but revascularization as treatment for MI in these populations has not been adequately studied. Significant research is required to understand the extent of disparities in treatment in these subpopulations.
Core tip: Disparities persist in the care of myocardial infarction (MI) in women and racial/ethnic minorities in the United States. They arrive at the hospital later, present with more risk factors and co-morbidities, and are less likely to receive guideline treatments. Women and blacks are less likely to receive revascularization. Younger women have more in-hospital mortality, and both blacks and women have greater long-term risk for death, recurrent MI, and re-hospitalization. Disparities in risk factors and co-morbidities among Hispanics/Latinos are complicated by the many subgroups. American Indians/Alaska Natives and Asian subpopulations have been much less studied, but surveillance data indicate more risk factors and co-morbidities among these subgroups.