AHRQ Study Finds Race, Not Gender, Limits Access to Life-saving Therapies for Heart Attack

Research Alert: April 12, 2000

African-American Medicare beneficiaries, regardless of gender, are significantly less likely than whites to receive reperfusion therapies which open blocked arteries to prevent a potential heart attack, according to a new study funded by the Agency for Healthcare Research and Quality (AHRQ). The study, conducted by researchers of the University of Alabama at Birmingham, adds to the current body of evidence on racial disparities and access to health care. This study will be published in the April 13, 2000, New England Journal of Medicine.

More than 1 million patients in the U.S. have heart attacks each year, and most of them are candidates for reperfusion therapies as recommended by the American College of Cardiology and the American Heart Association. The most common technique to restore blood flow to the heart is to use thrombolytic drugs, or as an alternative, primary angioplasty.

However, researchers found that only 57 percent of all patients who were eligible for this treatment actually received it. White men were most likely to receive the reperfusion therapies (59 percent), followed by white women (56 percent), black men (50 percent), and black women (44 percent). However, after careful analyses accounting for differences in age, symptoms, and results of diagnostic tests, it was blacks regardless of gender who were less likely than whites to receive this potentially life-saving therapy.

According to researchers, the reasons for the lower rate of reperfusion therapy use in blacks are not readily apparent, but they may include: the preferences of the patient, the expertise and preferences of the physician, hospital barriers to treatment, or unrecognized differences in patients' symptoms associated with race. Other likely explanations are: clinical ambiguity about the treatments, lack of training or insufficient knowledge, and physicians' own preferences or biases. Finally, cultural barriers may have contributed to racial disparities in the administration of these therapies.

Researchers reviewed the medical records of 234,769 Medicare beneficiaries in the U.S. from February 1994 to July 1995. From those records, 26,575 white and black patients met the strict eligibility criteria for reperfusion therapy. Statistical analyses of prevalence ratios determined the predictors of reperfusion use, dividing the study population into four subgroups of patients by race and sex.

AHRQ plans to spend up to $20 million over the next five years to fund up to four centers of excellence to study the root causes of disparities and develop strategies to eliminate them. This new program was developed to respond to the U.S. Department of Health and Human Services' Initiative on Eliminating Racial and Ethnic Disparities, and the U.S. Surgeon General's Healthy People 2010 Goal to eliminate disparities in health by the year 2010. Go to http://www.ahrq.gov/fund/ and http://www.nih.gov/grants/guide/index.html for further details.

Editor's Note: The study is entitled: "Relation of Race and Sex to the Use of Reperfusion Therapy in Medicare Beneficiaries with Acute Myocardial Infarction" by John G. Canto, M. D.; M.S.P.H., Jerdan J. Allison, M.D.; Catarina I. Kiefe, Ph.D., M.D.; Contessa Fincher, M.P.H.; Robert Farmer; Padmini Sikar, M.S.; Sharina Person, Ph.D.; and Norman W. Weissman, Ph.D. For details or interviews, call Dr. Canto at (202) 934-2936.

For additional information, contact AHRQ Public Affairs, (301) 427-1364.