Race-Based Characteristics May Mediate Differences in Acute Myocardial Infarction Outcomes

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Substantial differences were found between black and white participants in demographic, socioeconomic, psychosocial, clinical, disease severity, and health status characteristics.
Substantial differences were found between black and white participants in demographic, socioeconomic, psychosocial, clinical, disease severity, and health status characteristics.

A recent study in JAMA Network Open suggests that characteristics associated with race may potentially contribute to racial disparities observed in acute myocardial infarction (AMI) outcomes and mortality.

The study sought to analyze participant characteristics (ie socioeconomic, health, social support, and psychological status and treatment) to determine how they differ by race, whether they are associated with 1 or 5 year survival time post-AMI, and whether race plays a role.

The study utilized 2 multi-center prospective AMI registries (Prospective Registry Evaluating Myocardial Infarction: Events and Recovery [PREMIER] and Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status [TRIUMPH]), to identify a study population of 6402 participants who self-identified as black or white.

Querying of the National Death Index provided survival times (1 through 5 years). The study population demographics were as such: black (25.7%), women (33.2%), and mean age (60±13 years).

The study showed substantial differences between black and white participants in demographic, socioeconomic, psychosocial, clinical, disease severity, and health status characteristics.

For black participants, the mean age was lower (57±12.5 years vs 61±12.5 years (white participants), P <.001), there were fewer male participants (55% vs 71% [white participants]), and most were associated with worse survival (lower socioeconomic status, poorer social support, greater history of myocardial infarction and heart failure, and worse health status).

The authors showed the greatest separation between the races was socioeconomic factors. Also, they noted the largest contributing factor was the median income of the participants' zip code.

The 1 year and 5 year mortality rates for black participants (10.6% and 28.9%) and for white participants (5.8% and 18.0%).

The authors noted a “strong association between the propensity associated with being a black individual and increased risk of mortality, regardless of patient race”. 

The authors noted several study limitations, which include the lack of generalizability of the data registries, the observational study design, lack of genomic data due to self-identification of race, and the age of the registry in relation to recent treatment and outcomes.

The authors conclude there are numerous “characteristics associated with race that likely contribute to racial disparities” observed in AMI outcomes and strongly associated with mortality.

Multiple authors declared associations with the pharmaceutical industry. Please refer to original reference for a full list of authors' disclosures.

Reference

Graham GN, Jones PG, Chan PS, Arnold SV, Krumholtz HM, Spertus JA. Racial disparities in patient characteristics and survival after acute myocardial infarction [published online November 2, 2018]. JAMA Netw Open. doi:10.1001/jamanetworkopen.2018.4240

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