Racial Differences in the Treatment of Heart Disease

急性心肌梗死和心力衰竭是美国老年患者发病和死亡的常见原因。许多研究表明，在各种临床环境中，少数民族人群接受的心脏病护理比非西班牙裔白人少。这些研究集中在主要的程序，如冠状动脉旁路移植术使用大型行政和小型临床详细的数据库。这些差异是在增加还是在减少尚不清楚。种族和性别差异的原因也不清楚。一些研究已经证明，年龄，疾病的严重程度和保险状况可以解释部分，但不是所有观察到的治疗差异。医生、医院和地区特征是否影响治疗差异仍不清楚。此外，人们对种族群体之间在药物使用或戒烟咨询等侵入性较小的干预措施方面的差异知之甚少。这些治疗差异在多大程度上解释了生存率的差异也是未知的。本提案的目的是进一步研究美国老年患者中急性心肌梗死和心力衰竭治疗的种族差异。使用多个国家的数据集从卫生保健金融管理局（医疗保险）已经提供给调查人员，我们将研究的趋势，种族差异的治疗和结果的老年患者从1985年至1997年。来自医疗保险和国家心肌梗死登记处的详细临床数据将用于检查急性心肌梗死（阿司匹林、β受体阻滞剂、再灌注、血管紧张素转换酶抑制剂、戒烟咨询和血管造影）和心力衰竭（血管紧张素转换酶抑制剂、左心室功能测量）治疗适当性的种族差异。将通过将患者数据与手术拒绝（心血管合作项目）医生（美国医学会医生主文件）、医院（美国医院协会数据）和区域数据（邮政编码水平的人口普查局统计数据）联系起来，检查治疗差异的几个潜在原因。如果要实施系统的策略来减少老年患者治疗中的性别和种族差异，检查医生、医院和区域治疗差异是必要的。

Acute myocardial infarction and heart failure result are a common cause of morbidity and mortality for elderly patients in the United States. Numerous studies have documented that ethnic minority populations receive less intensive cardiac care than non-Hispanic whites in a variety of clinical settings. These studies have focused on major procedures such as coronary artery bypass grafting using both large administrative and small clinically detailed databases. Whether these differences are increasing, or decreasing is unclear. The reasons for racial and gender differences are also unclear. Several studies have documented that age, severity of illness, and insurance status can explain part, but not all of the observed differences in treatment. Whether physician, hospital and regional characteristics affect treatment differences remains unknown. In addition, little is known about differences between racial groups in less invasive interventions such as medication use or smoking cessation counseling. The degree to which these treatment differences explain differences in survival is also not known. The aim of this proposal is to further examine racial differences in treatment of acute myocardial infarction and heart failure among elderly patients in the United States. Using multiple national datasets from the Health Care Financing Administration (Medicare) already available to the investigators, we will examine trends in racial differences in treatment and outcome for elderly patients from 1985 through 1997. Detailed clinical data from Medicare and the National Registry of Myocardial Infarction will be used to examine racial differences in the appropriateness of care for acute myocardial infarction (aspirin, beta-blockers, reperfusion, angiotensin converting enzyme inhibitors, smoking cessation counseling and angiography) and heart failure (angiotensin converting enzyme inhibitors, measures of left ventricular function). Several potential causes of treatment differences will be examined by linking patient data to procedure refusal (Cooperative Cardiovascular Project) physician (American Medical Association Physician Master File), hospital (American Hospital Association data) and regional data (Census bureau statistics at the level of zip code). Examining the physician, hospital and regional variation in treatment differences are necessary if systematic strategies are to be implemented to reduce gender and racial disparities in the treatment of elderly patients.