TY - JOUR
T1 - Association between race/ethnicity and income on the likelihood of coronary revascularization among postmenopausal women with acute myocardial infarction
T2 - Women's health initiative study
AU - Tertulien, Tarryn
AU - Roberts, Mary B.
AU - Eaton, Charles B.
AU - Cene, Crystal W.
AU - Corbie-Smith, Giselle
AU - Manson, Jo Ann E.
AU - Allison, Matthew
AU - Nassir, Rami
AU - Breathett, Khadijah
N1 - Funding Information:
Dr. Breathett has research funding from National Heart, Lung, and Blood Institute (NHLBI) R56HL159216 , K01HL142848 , R25HL126146 subaward 11692sc , and L30HL148881 ; and Women As One. The Women's Health Initiative program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts HHSN268201100046C , HHSN268201100001C , HHSN268201100002C , HHSN268201100003C , HHSN268201100004C , and HHSN271201100004C .
Funding Information:
The WHI is a national health study sponsored by the National Institutes of Health (NIH), National Heart, Lung, and Blood Institute (NHLBI). It is a study of United States postmenopausal women followed for greater than 20 years to evaluate cardiovascular disease (including coronary heart disease, congestive heart failure, stroke, angina, peripheral vascular disease, carotid artery disease, coronary revascularization), cancer, and osteoporosis. 23 The original study is one of the largest women-only population studies, including 161,808 postmenopausal women aged 50 to 79 years who enrolled in one or more of its clinical trials (CT) or the observational studies (OS) between 1993 and 1998. 23 , 24 The study includes self-reported medical information collected through interviews and surveys by WHI personnel and the review of medical records for outcome determination. 25 , 26
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2022/4
Y1 - 2022/4
N2 - Background: Historically, race, income, and gender were associated with likelihood of receipt of coronary revascularization for acute myocardial infarction (AMI). Given public health initiatives such as Healthy People 2010, it is unclear whether race and income remain associated with the likelihood of coronary revascularization among women with AMI. Methods: Using the Women's Health Initiative Study, hazards ratio (HR) of revascularization for AMI was compared for Black and Hispanic women vs White women and among women with annual income <$20,000/year vs ≥$20,000/year over median 9.5 years follow-up(1993-2019). Proportional hazards models were adjusted for demographics, comorbidities, and AMI type. Results were stratified by revascularization type: percutaneous coronary intervention and coronary artery bypass grafting(CABG). Trends by race and income were compared pre- and post-2010 using time-varying analysis. Results: Among 5,284 individuals with AMI (9.5% Black, 2.8% Hispanic, and 87.7% White; 23.2% <$20,000/year), Black race was associated with lower likelihood of receiving revascularization for AMI compared to White race in fully adjusted analyses [HR:0.79(95% Confidence Interval:[CI]0.66,0.95)]. When further stratified by type of revascularization, Black race was associated with lower likelihood of percutaneous coronary intervention for AMI compared to White race [HR:0.72(95% CI:0.59,0.90)] but not for CABG [HR:0.97(95%CI:0.72,1.32)]. Income was associated with lower likelihood of revascularization [HR:0.90(95%CI:0.82,0.99)] for AMI. No differences were observed for other racial/ethnic groups. Time periods (pre/post-2010) were not associated with change in revascularization rates. Conclusion: Black race and income remain associated with lower likelihood of revascularization among patients presenting with AMI. There is a substantial need to disrupt the mechanisms contributing to race, sex, and income disparities in AMI management.
AB - Background: Historically, race, income, and gender were associated with likelihood of receipt of coronary revascularization for acute myocardial infarction (AMI). Given public health initiatives such as Healthy People 2010, it is unclear whether race and income remain associated with the likelihood of coronary revascularization among women with AMI. Methods: Using the Women's Health Initiative Study, hazards ratio (HR) of revascularization for AMI was compared for Black and Hispanic women vs White women and among women with annual income <$20,000/year vs ≥$20,000/year over median 9.5 years follow-up(1993-2019). Proportional hazards models were adjusted for demographics, comorbidities, and AMI type. Results were stratified by revascularization type: percutaneous coronary intervention and coronary artery bypass grafting(CABG). Trends by race and income were compared pre- and post-2010 using time-varying analysis. Results: Among 5,284 individuals with AMI (9.5% Black, 2.8% Hispanic, and 87.7% White; 23.2% <$20,000/year), Black race was associated with lower likelihood of receiving revascularization for AMI compared to White race in fully adjusted analyses [HR:0.79(95% Confidence Interval:[CI]0.66,0.95)]. When further stratified by type of revascularization, Black race was associated with lower likelihood of percutaneous coronary intervention for AMI compared to White race [HR:0.72(95% CI:0.59,0.90)] but not for CABG [HR:0.97(95%CI:0.72,1.32)]. Income was associated with lower likelihood of revascularization [HR:0.90(95%CI:0.82,0.99)] for AMI. No differences were observed for other racial/ethnic groups. Time periods (pre/post-2010) were not associated with change in revascularization rates. Conclusion: Black race and income remain associated with lower likelihood of revascularization among patients presenting with AMI. There is a substantial need to disrupt the mechanisms contributing to race, sex, and income disparities in AMI management.
KW - Acute myocardial infarction
KW - CABG
KW - Coronary revascularization
KW - Income
KW - PCI
KW - Race/ethnicity
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U2 - 10.1016/j.ahj.2021.12.013
DO - 10.1016/j.ahj.2021.12.013
M3 - Article
C2 - 34998968
AN - SCOPUS:85123642323
VL - 246
SP - 82
EP - 92
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
ER -