The significance of racial segregation for CV disease

描述（由申请人提供）：种族隔离作为美国社会教育和社会经济不平等的原因被广泛研究。然而，很少有研究试图量化个别医疗保健市场中存在的隔离程度，而且几乎没有研究审查隔离对医疗保健中的种族差异的影响。本研究将探讨医疗保健市场隔离与黑人和白人急性心肌梗死（AMI）患者的医疗保健服务差异之间的联系，这种情况存在大量种族差异的证据。具体目标是：1。确定急性心肌梗死后冠状动脉血运重建术应用的隔离和种族差异之间的关系。2. 确定急性心肌梗死患者急性冠状动脉综合征死亡率和再入院的隔离和种族差异之间的关系。3. 确定在获得高质量医院方面，种族隔离与种族差异之间的关系。这项为期24个月的研究将分析1993年至2002年10年间非联邦医院收治的因急性心肌梗塞而接受医疗保险的病人的现有数据。该研究将使用社会学中广泛使用的两种经过验证的方法来测量医疗保健市场中的隔离，并将评估上述终点中隔离措施与种族差异之间的关系。其他分析将检查各个市场内隔离的变化以及隔离与其他医疗保健市场特征之间的关系。从这项研究中获得的关于种族隔离作为种族差异决定因素的重要性的知识，对于设计消除差异的有效战略至关重要。

DESCRIPTION (provided by applicant): Segregation has been widely studied as a cause of educational and socioeconomic inequities in American society. However, few studies have sought to quantify the degree of segregation that exists within individual health care markets, and virtually no studies have examined the impact of segregation on racial disparities in health care. This study will examine the link between segregation in health care markets and disparities in health care delivery for black and white patients with acute myocardial infarction (AMI), a condition for which there exists substantial evidence of racial disparities. The specific aims are to: 1. Determine relationships between segregation and racial disparities in the use of coronary revascularization after acute myocardial infarction. 2. Determine relationships between segregation and racial disparities in mortality and readmission for acute coronary syndrome in patients with acute myocardial infarction. 3. Determine relationships between segregation and racial disparities in access to high quality hospitals. The 24-month study will analyze existing data for Medicare patients admitted for AMI to non-federal hospitals during a 10-year period from 1993 through 2002. The study will measure segregation in health care markets using two validated methods that have been widely used in sociology and will evaluate relationships between the segregation measures and racial disparities in the endpoints described above. Additional analyses will examine changes in segregation over time within individual markets and relationships between segregation and other health care market characteristics. The knowledge gained from this study about the significance of segregation as a determinant of racial disparity will be essential for designing effective strategies for eliminating disparities.