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Black-white differences in mortality in idiopathic dilated cardiomyopathy: the Washington, DC, dilated cardiomyopathy
S S Coughlin1, J S Gottdiener, K L Baughman
1Department of Medicine, Lombardi Cancer Research Center, Georgetown University School of Medicine, Washington, DC.
Insights
Black patients with idiopathic dilated cardiomyopathy had significantly poorer survival rates compared to white patients. This disparity, even after adjusting for clinical factors, highlights potential issues in diagnosis, treatment, or underlying biological differences.
Area of Science:
- Cardiology
- Public Health
- Health Disparities
Background:
- Idiopathic dilated cardiomyopathy (IDCM) survival can be influenced by various factors.
- Racial and socioeconomic disparities are known to impact health outcomes.
- Understanding these disparities in IDCM is crucial for improving patient care.
Purpose of the Study:
- To investigate racial, socioeconomic, and clinical predictors of survival in IDCM.
- To identify factors contributing to survival differences between black and white patients with IDCM.
Main Methods:
- Retrospective analysis of 128 IDCM patients from five Washington, DC-area hospitals.
- Utilized proportional hazards models for univariate and multivariate survival analyses.
- Examined demographic, socioeconomic, clinical, and treatment variables.
Main Results:
- Black patients (80.5%) had lower survival rates (71.5% at 12 months, 63.6% at 24 months) compared to white patients (92.0% at 12 months, 86.3% at 24 months).
- Black patients were more likely to have lower income and education levels.
- In multivariate analysis, age and black race were significant independent predictors of mortality, with an adjusted relative risk of 5.41 for black patients.
Conclusions:
- Black race is an independent predictor of poorer survival in IDCM, even after accounting for clinical factors.
- Disparities may stem from disease severity at diagnosis, differences in cardiac care, comorbidities, or biological factors.
- Further research is needed to elucidate the mechanisms behind these racial survival differences in IDCM.
Abstract:
Racial, socioeconomic, and clinical factors were examined as predictors of survival in idiopathic dilated cardiomyopathy using cases from five Washington, DC-area hospitals. One hundred three (80.5%) of the patients were black and 25 (19.5%) were white. The black patients were less likely to have private health insurance, less educated on average, and more likely to have a household income of $15,000 or less (P < or = .05). No racial differences were found in cardiac medication usage, with the exception of beta blockers and antiarrhythmics. The cumulative survival among black patients at 12 and 24 months was 71.5% and 63.6%, respectively, as compared with 92.0% and 86.3% among whites. The 12-month survival of black patients with ventricular arrhythmias or an ejection fraction of less than 25% was particularly poor. Age, ventricular arrhythmias, ejection fraction, and cigarette usage were significant predictors of survival in univariate analysis using the proportional hazards model. The univariate association with black race was of borderline significance (P < or = .07). In multivariate analysis, age and race were statistically significant independent predictors of survival. A strong association with black race was observed with an estimated relative risk of mortality of 5.41 (P < or = .02) after adjustment for age, ejection fraction, ventricular arrhythmias, and educational attainment. Poorer survival among blacks may be caused by a greater severity of disease at the time of diagnosis or by racial differences in cardiac care, comorbid conditions, or biologic factors affecting survival.