Copyright
©The Author(s) 2016.
World J Cardiol. Jan 26, 2016; 8(1): 24-40
Published online Jan 26, 2016. doi: 10.4330/wjc.v8.i1.24
Published online Jan 26, 2016. doi: 10.4330/wjc.v8.i1.24
Table 1 Summary of current minority disparities related to cardiovascular disease[13]
| Total CVD prevalence and total CVD mortality are higher in females than in males |
| Black males have higher prevalence than white males (44.4% vs 36.6%) and higher mortality (369.2/100000 vs 278.4/100000) |
| Black females have higher prevalence than white females (48.9% vs 32.4%) and higher mortality (260.5/100000 vs 192.2/100000) |
| Mexican American males have lower prevalence than white males (33.4% vs 36.6%) |
| Mexican American females have lower prevalence than white females (30.7% vs 32.4%) |
| The prevalence of having ≥ 2 risk factors is highest among blacks (48.7%), followed by AI/AN (46.7%), and lowest among Asians (25.9%). The prevalence is similar among men (37.8%) and women (36.4%) |
| The prevalence of having ≥ 2 risk factors is lower among college graduates (25.9%) than among those with less than a high school diploma (52.5%); a similar disparity in prevalence of risk factors is seen among those making ≥ $50000/yr (28.8%) vs those making < $10000/yr (52.5%) |
| Among older Americans (≥ 65 yr), hypertension is more prevalent in women than in men (57% vs 54%) and women have a significantly lower rate of hypertension control |
| Hypertension increased from 1988 through 2002 in both blacks and whites: From 35.8% to 41.4% in blacks (44.0% among black females) and from 24.3% to 28.1% in whites |
| Blacks develop hypertension earlier in life and have higher average blood pressures. As a result, blacks have a non-fatal stroke rate 1.3 times that of whites and a fatal stroke rate 1.8 times that of whites. Blacks also have a rate of death attributable to hypertension 1.5 times greater than that of whites and a 4.2-times-higher rate of end-stage kidney disease |
| Black and Mexican American males have higher mean LDL levels than white males (blacks, 115.9 mg/dL; Mexican Americans, 119.7 mg/dL; whites, 115.1 mg/dL); both black and Mexican American females have lower mean LDL levels than white females (blacks, 114.2 mg/dL; Mexican Americans, 115.0 mg/dL; whites 115.7 mg/dL) |
| Among men, non-Hispanic blacks (38%) and Mexican Americans (36%) are more likely than non-Hispanic whites (34%) to be obese. Among women, non- Hispanic blacks (54%) and Mexican Americans (45%) are more likely to be obese than non-Hispanic whites (33%) |
| The prevalence of physician-diagnosed diabetes mellitus in adults > 20 yr is highest in non-Hispanic blacks (12.6%) followed by Hispanics (11.8%), Asian Americans (8.4%), and non-Hispanic whites (7.1%). The prevalence of diagnosed diabetes in adult Asian Indians is more than twice as high (14%) as that in Chinese (6%) or Japanese (5%) Americans. Death rates per 100000 attributable to diabetes mellitus are 23.1 for white males, 43.6 for black males, 15.6 for white females, and 35.1 for black females |
| The age-adjusted prevalence of diabetes in AI/AN adults aged < 35 yr rose from 8.5% to 17.1% between 1994 and 2004; the rate was higher in females in all age groups |
Table 2 Summary of disparities in acute myocardial infarction co-morbidities and presentation symptoms, care and access to medical resources, and outcomes in women
| Co-morbidities and presentation symptoms |
| More hypertension and diabetes than men[24] |
| More diabetes, dyslipidemia, obesity, angina, stroke, and congestive heart failure; worse physical function; and poorer quality of life than men[28] |
| More hypertension, diabetes, lung disease, depression, and angina; worse general health scores; poorer physical function; and worse quality of life than men[30] |
| Women ≤ 55 yr of age more likely than men to present without chest pain or with NSTEMI[35] |
| Women < 45 yr of age more likely than men to present without chest pain, but this reversed with age[36] |
| Risk less likely to be accurately assessed by standard models or assays[39,40] |
| More likely than men to be older and have hypertension, hyperlipidemia, and congestive heart failure and less likely to have previous history of MI or revascularization[44] |
| Women ≤ 55 yr of age more likely to have low income, more diabetes, more hypertension, more family history of CVD, more previous CVD events, and more depression and anxiety; less likely to have diagnosis of STEMI and more likely to have NSTEMI or unstable angina[46] |
| Higher baseline stress than men[67] |
| Care/medical resources |
| Lower rates of hospitalization for AMI and lower rates of PCI as treatment for AMI compared to men[42] |
| Longer pre-hospital delay from onset of symptoms compared to men[43] |
| Longer symptom-onset-to-balloon time than men and more likely to be treated with medical management only; less likely to receive b-blockers and statins on discharge[44] |
| Greater delays than men in both door-to-code and door-to-balloon times[45] |
| Less likely than men to receive ECG or fibrinolytic therapy within guideline times, to have reperfusion therapy with STEMI, or to have PCI with NSTEMI[46] |
| Longer door-to-thrombolytic time than men[47] |
| Less likely than men to have statin treatment for high cholesterol[48] |
| Women with in-hospital STEMI less likely to have cardiac catheterization or PCI than men[49] |
| Less likely than men to be using ACE inhibitors, angiotensin receptor blockers, and β-blockers 30 d after discharge[50] |
| Less likely than men to be told their symptoms could be related to heart disease or to have cardiovascular testing or cardiac catheterization recommended[51] |
| Less likely than men to be treated with either primary PCI or CABG[73] |
| Outcomes |
| Greater mortality than men at 30 d and at 1 yr in women < 65 yr, but only at 30 d in women ≥ 65 yr[24] |
| Greater in-hospital mortality than men for both STEMI and NSTEMI in women ≤ 69 yr[58] |
| Greater in-hospital mortality than men for STEMI in women < 80 yr, and greater in-hospital mortality than men for NSTEMI in women ≤ 69 yr[59] |
| More in-hospital mortality for AMI than men[60] |
| Higher 30-d mortality rates for AMI than men up to age 75 yr[61] |
| Higher post-AMI mortality rates than men at both 5 and 10 yr[62] |
| More in-hospital complications than men, including mortality, MI, bleeding, and vascular complications[63] |
| More likely than men to be re-hospitalized for ACS within 1 yr[64] |
| Worse recovery than men at 1 mo post-AMI in angina, overall quality of life, and mental health[67] |
| Clinically significant lower health-related quality of life scores than men at 1, 6, and 12 mo following ACS event[68] |
| Higher re-hospitalization rates and lower quality of life than men at 6 mo after AMI[69] |
| Greater risk of 1-yr re-hospitalization for AMI and higher 1-yr mortality than men[93] |
Table 3 Summary of disparities in acute myocardial infarction co-morbidities and presentation symptoms, care and access to medical resources, and outcomes in blacks
| Co-morbidities and presentation symptoms |
| More likely than whites to have dyslipidemia, hypertension, obesity, insulin resistance, hyperglycemia, diabetes, and chronic kidney disease and to be physically inactive, smoke, and have poor eating habits[2] |
| More likely than whites to be younger and female and to have hypertension, diabetes, congestive heart failure, renal insufficiency, and history of smoking and stroke; less likely to have private insurance or cardiology care and to be uninsured[74] |
| More likely than whites to have Medicaid as insurer; to have no education beyond high school; to have low income; and to have a history of congestive heart failure, hypertension, and diabetes[76] |
| Likely to be younger and to have less education than whites; to have more hypertension, diabetes, higher BMI, and more current tobacco use; also more likely to experience palpitations, chest pressure, and chest pain[77] |
| More likely than whites to be younger and female and to have more hypertension, diabetes, renal insufficiency, history of smoking, congestive heart failure, previous MI, history of gastrointestinal bleeding, and lower baseline hemoglobin; also more likely to be on Medicaid or uninsured[78] |
| Care/medical resources |
| Less likely to be treated with either PCI or CABG within 3 mo of AMI than whites[23] |
| Longer door-to-drug and door-to-balloon times than for whites[79] |
| Less likely than whites to have door-to-balloon times < 90 min[80] |
| Likely to be transferred to a revascularization hospital more slowly than whites[81] |
| Less likely than whites to receive revascularization treatment[82] |
| Less likely than whites or Hispanics to receive revascularization treatment[83] |
| Less likely to be treated with revascularization than whites regardless of insurance status[84] |
| Less likely than whites to receive cardiac catheterization, PTCA, or CABG[85] |
| Persistently lower PCI rates in blacks compared to whites[86] |
| Less likely than whites to be transferred to a hospital with revascularization services or to be revascularized[87] |
| Less likely than whites to take their cardiac medications, to undergo non–protocol mandated angiography, or to receive a stent if undergoing PCI; less procedural success with PCI[89] |
| Outcomes |
| More likely to be discharged alive when not treated with revascularization than whites not receiving revascularization[83] |
| Lower mortality than in whites at 30 d post-AMI but higher thereafter[87] |
| Higher rates of recurrent AMI, congestive heart failure, and mortality than whites at 5 yr post-PCI[88] |
| Higher risk of death, recurrent MI, or re-hospitalization than whites[89] |
| Higher risk of death than whites following CABG[91] |
| More likely than whites to have adverse cardiac outcomes at 1 yr post-revascularization[92] |
| Consistently more likely than whites to have AMI re-hospitalization at 1 yr[93] |
| Both with and without pre-operative β-blockers, shorter median survival times with CABG than white patients[96] |
Table 4 Summary of disparities in acute myocardial infarction co-morbidities and presentation symptoms, care and access to medical resources, and outcomes in Hispanics
| Co-morbidities and presentation symptoms |
| More likely than non-Hispanic whites to have hypertension, diabetes, and renal failure and to lack health insurance[95] |
| More likely than non-Hispanic whites to be younger and to have diabetes, but less likely to have previous MI or prior revascularization[101] |
| More likely than non-Hispanic whites to have diabetes[103] |
| Care/medical resources |
| Longer door-to-drug and door-to-balloon times than for whites[79] |
| Longer door-to-drug and door-to-balloon times than for whites[79] |
| Less likely than whites to receive catheterization or PTCA[104] |
| Outcomes |
| Hispanic patients with diabetes somewhat less likely at 5 yr to be dead, have MI, or have stroke than white patients with diabetes[90] |
| More likely to be dead or re-hospitalized at 1 yr than non-Hispanic whites[95] |
| In-hospital mortality increases with age and is higher among Hispanic females[105] |
- Citation: Graham G, Xiao YYK, Rappoport D, Siddiqi S. Population-level differences in revascularization treatment and outcomes among various United States subpopulations. World J Cardiol 2016; 8(1): 24-40
- URL: https://www.wjgnet.com/1949-8462/full/v8/i1/24.htm
- DOI: https://dx.doi.org/10.4330/wjc.v8.i1.24