Abstract 14: Disparities in Cardiovascular Disease Outcomes Among Pregnant Females

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Mohamed M Gad ◽  
Islam Y Elgendy ◽  
Ahmed M Mahmoud ◽  
Anas M Saad ◽  
Hani Jneid ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Pulmonary Embolism ◽  
African American ◽  
African Americans ◽  
Hospital Mortality ◽  
Pregnant Women ◽  
Racial Disparities ◽  
The United States ◽  
Median Income ◽  
White Patients

Introduction: The incidence of cardiovascular (CV) disease among pregnant women is rising in the United States (US). Data on racial disparities for the major CV events during pregnancy are limited. Methods: Pregnant women hospitalized from January 2007 to September 2015 were identified in the Nationwide Inpatient Sample. Outcomes of interest were mortality, myocardial infarction (MI), stroke, and pulmonary embolism (PE). Multivariate regression analysis was used for Odds Ratio (OR) and 95% Confidence Interval (CI). Results: Among 37,524,315 pregnant women, 17,159,400 (45.7%) were White, 4,921,574 (13.1%) were African American, and 7,111,216 (19.0%) were Hispanic. Following 2010, trends of mortality and stroke declinedsignificantly in African Americans, however, were stable in Whites (Figure). In-hospital mortality was 13.52 per 100,000 hospitalizations. The incidence of in-hospital mortality was highest among AfricanAmericans followed by White, then Hispanic patients; 29.63, 10.61, and 9.73 per 100,000 hospitalizations, respectively. The majority of African Americans (61.9%) were insured by Medicaid while the majority of White patients had private insurance (61.9%). Most of African American patients were below-median income (70.54%) while nearly half of the White patients were above the median income (47%). Compared to Whites, African Americans had the highest mortality with OR of 2.79, 95% CI (2.61-2.99), myocardial infarction with OR of 2.178, 95% CI (2.01-2.36), stroke with OR of 2.04, 95% CI (1.96-2.13), and pulmonary embolism with OR of 1.95, 95% CI (1.82-2.08). Conclusions: Significant racial disparities exist in the major CV events among pregnant women. Further efforts are needed to minimize these differences.

Abstract 491: Racial Disparities in the Trends of Acute Myocardial Infarction Outcomes Among Medicaid Patients, 2007-2011

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Oluwole M Adegbala ◽  
Akintunde Akinjero ◽  
Samson Alliu ◽  
Adeyinka C Adejumo ◽  
Emmanuel Akintoye ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
African Americans ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Racial Disparities ◽  
Racial Differences ◽  
Length Of Hospital Stay ◽  
The United States ◽  
Racial Groups

Background: Although, in-hospital mortality from acute myocardial infarction (AMI) have declined in the United States recently, there is a gap in knowledge regarding racial differences in this trend. We sought to evaluate the effect of race on the trends in outcomes after Acute Myocardial Infarction among Medicaid patients in a nationwide cohort from 2007-2011 Methods: We extracted data from the Nationwide Inpatient Sample (NIS) for all hospitalizations between 2007 and 2011 for Medicaid patients aged 45 years or older with principal diagnosis of AMI using ICD-9-CM codes. Primary outcome of this study was all cause in-hospital mortality. We then stratified hospitalizations by racial groups; Whites, African Americans and Hispanics, and assessed the time trends of in-hospital mortality before and after multivariate analysis. Results: The overall mortality from AMI among Medicaid patients declined during the study period (8.80% in 2007 to 7.46% in 2011). In the adjusted models, compared to 2007, in-hospital mortality from AMI for Medicaid patients decreased across the 3 racial groups; Whites (aOR= 0.88, CI=0.70-0.99), African Americans (aOR=0.76, CI=0.57-1.01), Hispanics (aOR=0.87, CI=0.66-1.25). While the length of hospital stay declined significantly among African American and Hispanic with 2 days and 1.76 days decline respectively, the length of stay remained unchanged for Whites. There was non-significant increase in the incidence of stroke across the various racial groups; Whites (aOR= 1.23, CI=0.90 -1.69), African Americans (aOR=1.10, CI=0.73 -1.64), Hispanics (aOR=1.03, CI=0.68-1.55) when compared to 2007. Conclusion: In this study, we found that in-hospital mortality from AMI among Medicaid patients have declined across the racial groups. However, while the length of stay following AMI declined for African Americans and Hispanics with Medicaid insurance, it has remained unchanged for Whites. Future studies are necessary to identify determinants of these significant racial disparities in outcomes for AMI.

scholarly journals The association of Medicaid expansion and racial/ethnic inequities in access, treatment, and outcomes for patients with acute myocardial infarction

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241785
Author(s):  
Erica M. Valdovinos ◽  
Matthew J. Niedzwiecki ◽  
Joanna Guo ◽  
Renee Y. Hsia
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Racial Disparities ◽  
Hospital Admissions ◽  
Hospital Readmissions ◽  
Medicaid Expansion ◽  
Difference In Differences ◽  
Percentage Points ◽  
White Patients

Introduction After having an acute myocardial infarction (AMI), racial and ethnic minorities have less access to care, decreased rates of invasive treatments such as percutaneous coronary intervention (PCI), and worse outcomes compared with white patients. The objective of this study was to determine whether the Affordable Care Act’s expansion of Medicaid eligibility was associated with changes in racial disparities in access, treatments, and outcomes after AMI. Methods Quasi-experimental, difference-in-differences-in-differences analysis of non-Hispanic white and minority patients with acute myocardial infarction in California and Florida from 2010–2015, using linear regression models to estimate the difference-in-differences. This population-based sample included all Medicaid and uninsured patients ages 18–64 hospitalized with acute myocardial infarction in California, which expanded Medicaid through the Affordable Care Act beginning as early as July 2011 in certain counties, and Florida, which did not expand Medicaid. The main outcomes included rates of admission to hospitals capable of performing PCI, rates of transfer for patients who first presented to hospitals that did not perform PCI, rates of PCI during hospitalization and rates of early (within 48 hours of admission) PCI, rates of readmission to the hospital within 30 days, and rates of in-hospital mortality. Results A total of 55,991 hospital admissions met inclusion criteria, 32,540 of which were in California and 23,451 were in Florida. Among patients with AMI who initially presented to a non-PCI hospital, the likelihood of being transferred increased by 12 percentage points (95% CI 2 to 21) for minority patients relative to white patients after the Medicaid expansion. The likelihood of undergoing PCI increased by 3 percentage points (95% CI 0 to 5) for minority patients relative to white patients after the Medicaid expansion. We did not find an association between the Medicaid expansion and racial disparities in overall likelihood of admission to a PCI hospital, hospital readmissions, or in-hospital mortality. Conclusions The Medicaid expansion was associated with a decrease in racial disparities in transfers and rates of PCI after AMI. We did not find an association between the Medicaid expansion and admission to a PCI hospital, readmissions, and in-hospital mortality. Additional factors outside of insurance coverage likely continue to contribute to disparities in outcomes after AMI. These findings are crucial for policy makers seeking to reduce racial disparities in access, treatment and outcomes in AMI.

scholarly journals Real-World Disparities in Daratumumab Utilization for Patients with Relapsed or Refractory Multiple Myeloma (MM)

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4734-4734
Author(s):  
Kathleen Maignan ◽  
Daniel Backenroth ◽  
Neil A. McQuarrie ◽  
Nicole G. Lipitz ◽  
Erin R. Williams ◽  
...  
Keyword(s):  
African American ◽  
African Americans ◽  
Real World ◽  
The United States ◽  
New Drugs ◽  
Absolute Difference ◽  
The Real ◽  
Start Date ◽  
Chi Squared ◽  
White Patients

Abstract Introduction In the last 3 years, 4 new drugs indicated for MM have been approved, positively affecting the prognosis of patients with this disease. While these novel therapies offer therapeutic options to patients who have failed other treatments, adoption of new agents has historically lagged in African Americans, potentially limiting improvement in outcomes for this population. One of the newer drugs is daratumumab, a fully human anti-CD38 monoclonal antibody, first approved in November 2015 to treat relapsed or refractory disease in 3rd and 4th lines of therapy (LoTs). We sought to examine differences in daratumumab uptake stratified by race and identify factors associated with use of this drug in the real world. Methods This retrospective cohort study used information from the Flatiron Health (FlH) database, which is derived from pooled electronic health record (EHR) data; Institutional Review Board approval with a waiver of informed consent was obtained. The cohort included 3240 patients followed for MM from 11/16/2015 to 05/31/2018 across the United States and was limited to patients with a confirmed diagnosis of MM, who received at least one LoT starting on 11/16/2015 or later, and who were white or African American. Patients whose start of MM treatment (captured through chart review) was > 30 days before the start of structured activity in the FlH database were excluded as this may indicate missing therapy data. The proportion of LoTs including daratumumab stratified by year of LoT start was plotted for African-American and white patients. P values were calculated using chi-squared and Kruskal-Wallis tests. Results African-American patients were less likely to receive daratumumab for any LoT than white patients (12.1% vs. 15.4%, P = 0.041). Daratumumab uptake increased year by year, but net adoption lagged in African-American patients compared to white patients (Figure). For LoTs with a start date in 2015 (after 11/16/2015), 2.0% of those received by African-American patients included daratumumab, compared to 2.5% of those received by white patients. For the first 5 months of 2018 (before 05/31/2018), these percentages increased to 15.8% for African-American patients and 16.8% for white patients. Patients receiving daratumumab for any LoT were more likely to be younger at diagnosis (median age 66 years, IQR: 59-73 years vs. 70 years, IQR: 62-77 years; P < 0.001) and to be followed at academic centers than at community clinics (13.8% vs. 10.4%, P = 0.031). Consistent with previous literature, African-American patients in this cohort were younger at diagnosis than white patients (median age at diagnosis 67 years, IQR: 59-74 years vs. 70 years, IQR: 62-77 years; P < 0.001), and fewer were followed at academic centers (7.3% vs. 11.8%, P = 0.001). Conclusions While the absolute difference in daratumumab utilization is modest, this disparity has persisted over the last 3 years, with African-American patients lagging behind white patients. This trend may indicate inequities in access to and utilization of expensive newer treatments, which is particularly notable because of the higher incidence of MM in African Americans. Our study was limited as it did not control for gender, regional differences, cytogenetics, or insurance type. Further research is also required to determine if the observed treatment differences are associated with differences in clinical outcomes. To our knowledge, this is the first study to examine racial disparities in daratumumab uptake using recent, EHR-derived data from the real world. Disclosures Maignan: Flatiron Health: Employment. Backenroth:Flatiron Health: Employment. McQuarrie:Flatiron Health: Employment. Lipitz:Flatiron Health: Employment. Williams:Flatiron Health: Employment. Carson:Flatiron Health: Employment.

scholarly journals No Racial Disparities in the Treatment of ST Elevation Myocardial Infarction – A Community-based Experience

2013 ◽  
Vol 8 (2) ◽  
pp. 140
Author(s):  
Abhijeet Basoor ◽  
Gagan Randhawa ◽  
John F Cotant ◽  
Nishit Choksi ◽  
Abdul R Halabi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
African Americans ◽  
Hospital Mortality ◽  
Racial Disparities ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
St Elevation Myocardial Infarction ◽  
Community Based ◽  
St Elevation

Whether racial disparities exist in the treatment of ST elevation myocardial infarction (STEMI) is not exactly known. We report a retrospective chart review of patients with first event of STEMI, in two groups separated by one decade. Results revealed that hospital mortality in the 2007 and 1997 groups for African Americans versus Caucasians was one of 22 versus 21 of 170, 95 % confidence interval (CI) -0.178 to 0.022, p=0.48 and four of 41 versus 39 of 402, 95 % CI -0.095 to 0.096, p=1.00, respectively. The mean length of stay (LOS) for African Americans and Caucasians in the 2007 and 1997 groups was 5.7 versus 4.1 days (p=0.09) and 7.3 versus 6.6 days (p=0.42), respectively. During follow-up, a total of 40 patients needed re-intervention in the 2007 group. The re-intervention rate in African American patients being 13.6 % (three of 22) versus 21.2 % (36 of 170) in Caucasians, 95 % CI -0.231 to 0.081, with p=0.57. In conclusion, there was no evidence of racial disparity in the treatment of STEMI in terms of hospital mortality, length of hospital stay and re-intervention rate.

Religion, Race, and Humanism

2018 ◽  
Author(s):  
Anthony B. Pinn
Keyword(s):  
United States ◽  
African American ◽  
African Americans ◽  
Richard Wright ◽  
Institutional Development ◽  
The United States ◽  
Unitarian Universalist ◽  
Racial Injustice ◽  
History Of ◽  
Lorraine Hansberry

This chapter explores the history of humanism within African American communities. It positions humanist thinking and humanism-inspired activism as a significant way in which people of African descent in the United States have addressed issues of racial injustice. Beginning with critiques of theism found within the blues, moving through developments such as the literature produced by Richard Wright, Lorraine Hansberry, and others, to political activists such as W. E. B. DuBois and A. Philip Randolph, to organized humanism in the form of African American involvement in the Unitarian Universalist Association, African Americans for Humanism, and so on, this chapter presents the historical and institutional development of African American humanism.

A Discussion of Ismail K. White and Chryl N. Laird’s Steadfast Democrats: How Social Forces Shape Black Political Behavior

2021 ◽  
Vol 19 (1) ◽  
pp. 209-210
Author(s):  
Michael Leo Owens
Keyword(s):  
African American ◽  
African Americans ◽  
Political Behavior ◽  
Democratic Party ◽  
The United States ◽  
Social Forces ◽  
Individual Level ◽  
The Individual ◽  
Behavioral Norm ◽  
Black Political Behavior

Charge: As Ismail K. White and Chryl N. Laird note, collectively more than 80% of African Americans self-identify as Democrats according to surveys, and no Republican presidential candidate has won more than 13% of the Black vote since 1968. This is true despite the fact that at the individual level many African Americans are increasingly politically moderate and even conservative. Against this backdrop, what explains the enduring nature of African American support for the Democratic Party? In Steadfast Democrats: How Social Forces Shape Black Political Behavior, White and Laird answer this question by developing the concept of “racialized social constraint,” a unifying behavioral norm meant to empower African Americans as a group and developed through a shared history of struggle against oppression and for freedom and equality. White and Laird consider the historical development of this norm, how it is enforced, and its efficacy both in creating party loyalty and as a path to Black political power in the United States. On the cusp of perhaps the most consequential presidential election in American history, one for which African American turnout was crucial, we asked a range of leading political scientists to assess the relative strengths, weaknesses, and ramifications of this argument.

scholarly journals Mortality of major cardiovascular emergencies among patients admitted to hospitals on weekends as compared with weekdays in Taiwan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chao-Lun Lai ◽  
Raymond Nien-Chen Kuo ◽  
Ting-Chuan Wang ◽  
K. Arnold Chan
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Pulmonary Embolism ◽  
Ischemic Stroke ◽  
Aortic Aneurysm ◽  
Hospital Mortality ◽  
Weekend Effect ◽  
Claims Database ◽  
Ruptured Aortic Aneurysm ◽  
Incident Cases

Abstract Background Several studies have found a so-called weekend effect that patients admitted at the weekends had worse clinical outcomes than patients admitted at the weekdays. We performed this retrospective cohort study to explore the weekend effect in four major cardiovascular emergencies in Taiwan. Methods The Taiwan National Health Insurance (NHI) claims database between 2005 and 2015 was used. We extracted 3811 incident cases of ruptured aortic aneurysm, 184,769 incident cases of acute myocardial infarction, 492,127 incident cases of ischemic stroke, and 15,033 incident cases of pulmonary embolism from 9,529,049 patients having at least one record of hospitalization in the NHI claims database within 2006 ~ 2014. Patients were classified as weekends or weekdays admission groups. Dates of in-hospital mortality and one-year mortality were obtained from the Taiwan National Death Registry. Results We found no difference in in-hospital mortality between weekend group and weekday group in patients with ruptured aortic aneurysm (45.4% vs 45.3%, adjusted odds ratio [OR] 1.01, 95% confidence interval [CI] 0.87–1.17, p = 0.93), patients with acute myocardial infarction (15.8% vs 16.2%, adjusted OR 0.98, 95% CI 0.95–1.00, p = 0.10), patients with ischemic stroke (4.1% vs 4.2%, adjusted OR 0.99, 95% CI 0.96–1.03, p = 0.71), and patients with pulmonary embolism (14.6% vs 14.6%, adjusted OR 1.02, 95% CI 0.92–1.15, p = 0.66). The results remained for 1 year in all the four major cardiovascular emergencies. Conclusions We found no difference in either short-term or long-term mortality between patients admitted on weekends and patients admitted on weekdays in four major cardiovascular emergencies in Taiwan.

Tornadoes, poverty and race in the USA: A five-decade analysis

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Russ D. Kashian ◽  
Tracy Buchman ◽  
Robert Drago
Keyword(s):  
African American ◽  
African Americans ◽  
Study Finding ◽  
Median Income ◽  
Content Type ◽  
Vulnerable Communities ◽  
Long Run ◽  
Level Data ◽  
The Usa

PurposeThe study aims to analyze the roles of poverty and African American status in terms of vulnerability to tornado damages and barriers to recovery afterward.Design/methodology/approachUsing five decades of county-level data on tornadoes, the authors test whether economic damages from tornadoes are correlated with vulnerability (proxied by poverty and African American status) and wealth (proxied by median income and educational attainment), controlling for tornado risk. A multinomial logistic difference-in-difference (DID) estimator is used to analyze long-run effects of tornadoes in terms of displacement (reduced proportions of the poor and African Americans), abandonment (increased proportions of those groups) and neither or both.FindingsControlling for tornado risk, poverty and African American status are linked to greater tornado damages, as is wealth. Absent tornadoes, displacement and abandonment are both more likely to occur in urban settings and communities with high levels of vulnerability, while abandonment is more likely to occur in wealthy communities, consistent with on-going forces of segregation. Tornado damages significantly increase abandonment in vulnerable communities, thereby increasing the prevalence of poor African Americans in those communities. Therefore, the authors conclude that tornadoes contribute to on-going processes generating inequality by poverty/race.Originality/valueThe current paper is the first study connecting tornado damages to race and poverty. It is also the first study finding that tornadoes contribute to long-term processes of segregation and inequality.

Abstract WP178: Acute Stroke Ischemic Symptom Onset-to-Arrival Time in Michigan Hospitals

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Muhammad U Farooq ◽  
Kathie Thomas
Keyword(s):  
African American ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Patient Outcomes ◽  
Symptom Onset ◽  
Arrival Time ◽  
Heart Association ◽  
The United States ◽  
Stroke Patients ◽  
White Patients

Objectives: Stroke is the fifth-leading cause of death and the leading cause of disability in the United States. One of the primary goals of the American Heart Association/American Stroke Association is to increase the number of acute stroke patients arriving at emergency departments (EDs) within 1-hour of symptom onset. Earlier treatment with thrombolysis in patients with acute ischemic stroke translates into improved patient outcomes. The objective of this abstract is to examine the association between the use of emergency medical services (EMS) and symptom onset-to-arrival time in patients with ischemic stroke. Methods: A retrospective review of ischemic stroke patients (n = 8873) from 25 Michigan hospitals from January 2012-December 2014 using Get With the Guidelines databases was conducted. Symptom onset-to-ED arrival time and arrival mode were examined. Results: It was found that 17.4% of ischemic stroke patients arrived at the hospitals within 1-hour of symptom onset. EMS transported 69.1% of patients who arrived within 1-hour of symptom onset. During this 1-hour period African American patients (22%) were less likely to use EMS transportation as compared to White patients (72%). The majority of patients, 41.8%, arrived after 6-hours of symptom onset. EMS transported only 40% of patients who arrived after 6-hours of symptom onset. As before, during this 6-hour period African American patients (20%) were also less likely to use EMS transportation as compared to White patients (75%). Symptom onset-to-ED arrival time was shorter for those patients who used EMS. The median pre-hospital delay time was 2.6 hours for those who used EMS versus 6.2 hours for those who did not use EMS. Conclusions: The use of EMS is associated with a decreased pre-hospital delay, early treatment with thrombolysis and improved patient outcomes in ischemic stroke patients. Community interventions should focus on creating awareness especially in minority populations about stroke as a neurological emergency and encourage EMS use amongst stroke patients.

Abstract 123: A Comparison of In-Hospital Acute Myocardial Infarction Management Between Portugal and the United States: 2000 - 2010

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Mariana F Lobo ◽  
Vanessa Azzone ◽  
Luis Azevedo ◽  
Armando Teixeira-Pinto ◽  
Jose Pereira Miguel ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
The United States ◽  
Billing Data ◽  
Cross Sectional ◽  
Medical Technologies ◽  
Hospitalization Rates ◽  
The Us ◽  
International Comparative

Objectives: Because inter- and intra-country variations in the adoption of medical technologies exist, international comparative studies provide an opportunity to infer technology effectiveness. Few studies have characterized recent trends in acute myocardial infarction (AMI) management between countries. Methods: Repeated cross-sectional observational cohorts of hospitalized adults aged ≥20 years discharged between January 2000 and December 2010. We identified new AMI hospitalizations using a US national 20% inpatient sample and a 100% inpatient sample in all Portuguese public sector hospitals. Age, sex, comorbidities, and median length of stay (interquartile range [IQR]) were determined. Annual age-sex adjusted hospitalization rates (HR) for AMI, in-hospital procedures, and in-hospital mortality were directly standardized to the 2010 US population. Intra-country (2010 relative to 2000) and inter-country in 2010 (Portugal [PT] relative to US) rate ratios [RR] were estimated. Findings: We identified 1476808 AMI US hospitalizations and 126314 Portugal hospitalizations between 2000 and 2010. Portuguese patients were more male, younger, and had fewer comorbidities compared to US patients (Table). The age-sex adjusted AMI HR decreased from 21 per 1000 person-years to 15 in the US (RR=0.70; 95% CI = [0.70, 0.71]) but increased in PT (14 to 15 per 1000, RR = 1.17 [1.14, 1.21]). While crude procedure rates were uniformly lower in PT, only CABG rates differed after standardization (2010: RR=0.19 [0.14, 0.26]). PCI use increased annually in both countries and decreased for CABG in the US only (102 to 79, RR=0.77 [0.73, 0.81]). Standardized in-hospital mortality decreased within-country (US: 44 to 29 per 1000, RR= 0.65 [0.60, 0.72]; PT: 93 to 62 per 1000, RR= 0.67 [0.44, 1.00]). In 2010, PT mortality was twice that in the US. Conclusions: AMI hospitalization rates and use of medical technologies are higher in the US compared to Portugal. However, standardized rates reveal only CABG surgery rates differ significantly between the two countries. Outcomes, measured by hospital mortality and LOS, are generally better in the U.S. Inter-country disparities may be a consequence of differential use of technologies, differences in AMI epidemiology, patient risk, or quality of hospital billing data.

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