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US Initiative to Eliminate Racial and Ethnic Disparities in Health: The Impact on the Outcomes of
Niharika Bhatia1, Deep Vakil2, Stavros Zinonos3
1Rutgers Robert Wood Johnson Medical School Piscataway NJ USA.
Insights
The 1998 federal initiative reduced disparities in percutaneous coronary interventions for ST-segment-elevation myocardial infarction patients. Post-1998, mortality decreased across racial groups, with greater improvements seen in the Hispanic population.
Area of Science:
- Cardiovascular Medicine
- Health Disparities Research
- Public Health Policy
Background:
- Racial and ethnic health disparities remain a significant concern in the United States.
- A 1998 federal initiative aimed to eliminate these disparities, but its impact on ST-segment-elevation myocardial infarction (STEMI) outcomes was unclear.
- Understanding treatment access and mortality trends across different racial groups is crucial for effective public health interventions.
Purpose of the Study:
- To evaluate the impact of the 1998 federal initiative on percutaneous coronary intervention (PCI) use and mortality rates in Black, Hispanic, and White patients with first-time STEMI.
- To analyze trends in STEMI outcomes from 1994 to 2015, focusing on disparities in treatment and survival.
Main Methods:
- Analysis of STEMI patient data (1994-2015) from the Myocardial Infarction Data Acquisition System, including 7942 Black, 27,665 Hispanic, and 88,727 White patients.
- Logistic regression models were used to assess in-hospital mortality, adjusting for demographics, comorbidities, and interventional procedures.
- Linear regression with a change point analysis at 1998 was employed to evaluate mortality trends before and after the federal initiative.
Main Results:
- Percutaneous coronary intervention use increased across all racial groups from 1994 to 2015.
- PCI disparity favoring White patients pre-1998 was significantly reduced post-initiative, reversing in favor of Hispanic patients after 2005.
- In-hospital mortality showed a downward trend without significant disparity among the three groups after 1998. One-year all-cause and cardiovascular mortality decreased significantly for all groups post-1998, with the most substantial reduction observed in the Hispanic population.
Conclusions:
- The 1998 federal initiative likely contributed to reducing disparities in PCI utilization for STEMI patients.
- Significant reductions in both short- and long-term mortality were observed across all racial groups following the initiative.
- The Hispanic population experienced a more pronounced decrease in mortality, suggesting a positive impact of the initiative on this demographic.
Abstract:
Background In 1998, President Clinton launched a federal initiative to eliminate racial and ethnic health disparities. The impact on the outcomes of ST-segment-elevation myocardial infarction has not been well studied. Methods and Results ST-segment-elevation myocardial infarction outcomes from 1994 to 2015 were studied in 7942 Black, 27 665 Hispanic, and 88 727 White patients with first admission of ST-segment-elevation myocardial infarction using the Myocardial Infarction Data Acquisition System. Logistic regressions were used to assess mortality adjusting for demographics, comorbidities, and interventional procedures. There was an overall rise from 1994 to 2015 in the use of percutaneous coronary interventions in all 3 groups. Before 1998, White patients received more percutaneous coronary interventions compared with Black and Hispanic patients (P<0.05). After 1998, the disparity in use of percutaneous coronary interventions in Black and Hispanic patients was greatly reduced compared with White patients, and the difference reversed in favor of Hispanic patients after 2005 (P<0.05). There was an overall downward trend of in-hospital mortality without evidence of disparity among Black, Hispanic, and White patients. A linear regression model was used with a change point in 1998. Before 1998, the slope of 1-year all-cause and cardiovascular mortality was not statistically significant. After 1998, the mortality showed negative slopes for all 3 groups, however, with lower overall crude mortality for Hispanic patients compared with Black and White patients (P<0.0001). Conclusions The initiative launched in 1998 may have contributed to a reduction in percutaneous coronary intervention usage disparity in patients with ST-segment-elevation myocardial infarction. Short- and long-term mortality decreased in all 3 groups, but more in the Hispanic population.
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