Why does race still matter?

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Kaitlyn Dmyterko, staff writer

Despite the fact that cardiovascular care is improving overall, significant racial, ethnic and gender disparities are still plaguing the field. As we move forward, it will be imperative to understand why these disparities exist and what can be done to foil them.

Two studies published this week found that black MI patients wait longer to undergo advanced heart procedures compared with white patients. However, both found that these differences may not be driven by race itself, but instead where patients seek care.

In the first, University of Michigan researchers found that of the 25,847 acute MI patients analyzed, blacks had longer hospital stays and slower transfer times compared to whites. While the researchers said that the causes of these delays are unknown, the quality at these hospitals may have been worse.

In the second study, researchers from Duke found that while black patients lived closer to revascularization hospitals and high-quality hospitals, they were still more likely to be admitted to low-quality hospitals. Blacks were less likely to seek care at nearby hospitals, which may have decreased the timeliness of coronary reperfusion procedures, Cooke et al noted.

Similarly, a study published last September in Academic Emergency Medicine showed that blacks and Hispanics were less likely than whites to be referred for immediate care when presenting with chest pain. This defies the American College of Cardiology and American Heart Association guidelines that recommend patients presenting with chest pain undergo immediate electrocardiogram (ECG).

How can we end these care disparities?

A June 16 perspective in NEJM outlined how collecting data and linking them to quality measures may be just one way to reduce these types of disparities. Weissman and Hasnain-Wynia wrote that while many U.S. hospitals are already collecting these types of demographic data, few providers record these data systematically.

However, meaningful use criteria may change this. Now, practices will be required to record race or ethnic background for at least 50 percent of their patients. The authors said that until self-reported data become available, these indirect estimations will provide an opportunity to “populate vast quantities of health claims records with racial and ethnic information.”

As we move forward, initiatives must mirror those like the American College of Cardiology’s (ACCs) Quality First initiative. The goal of Quality First is to improve disparities of care by providing increased transparency and a bigger focus on outcomes. The first step to improving these disparities is understanding why they occur.

Kaitlyn Dmyterko
Senior writer, Cardiovascular Business