Cardiac Procedures among American Indians and Alaska Natives compared to Non-Hispanic Whites Hospitalized with Ischemic Heart Disease in California

Abstract

BackgroundAmerican Indians/Alaska Natives (AIAN) experience a high burden of cardiovascular disease with rates for fatal and nonfatal heart disease approximately twofold higher than the U.S. population.ObjectiveTo determine if disparities exist in cardiac procedure rates among AIAN compared to non-Hispanic whites hospitalized in California for ischemic heart disease defined as acute myocardial infarction or unstable angina.DesignCross-sectional study.EventsA total of 796 ischemic heart disease hospitalizations among AIAN and 90971 among non-Hispanic whites in 37 of 58 counties in California from 1998-2002.MeasurementsCardiac catheterization, percutaneous cardiac intervention, and coronary artery bypass graft surgery procedure rates from hospitalization administrative data.Main resultsAIAN did not have lower cardiac procedure rates for cardiac catheterization and percutaneous cardiac intervention compared to non-Hispanic whites (unadjusted OR 1.00, 95% CI 0.87–1.16 and OR 1.04, 95% CI 0.90–1.20, respectively). Adjustment for age, sex, comorbidities, and payer source did not alter the results (adjusted OR 0.95, 95% CI 0.82–1.10 and OR 0.98, 95% CI 0.85–1.14, respectively). We found higher odds (unadjusted OR 1.36, 95% CI 1.09–1.70) for receipt of coronary artery bypass graft surgery among AIAN hospitalized for ischemic heart disease compared to non-Hispanic whites which after adjustment attenuated some and was no longer statistically significant (adjusted OR 1.26, 95% CI 1.00–1.58).ConclusionAIAN were not less likely to receive cardiac procedures as non-Hispanic whites during hospitalizations for ischemic heart disease. Additional research is needed to determine whether differences in specialty referral patterns, patients’ treatment preferences, or outpatient management may explain some of the health disparities due to cardiovascular disease that is found among AIAN.

Validation of Diagnostic and Procedural Codes for Identification of Acute Cardiovascular Events in US Veterans with Rheumatoid Arthritis

“…A number of investigators have evaluated the accuracy of administrative coding for CV conditions, including the following: MI; 3 , 9 , 18 , 21 – 24 stroke and transient ischemic attack; 6 – 8 , 11 , 25 – 28 CABG surgery; 10 , 12 – 14 and various procedures within the spectrum of PCI, including percutaneous transluminal coronary angioplasty (PTCA) and cardiac catheterization. 10 , 12 – 14 …”

“…For example, many of the previously published manuscripts do not report the sensitivity or specificity of the codes used to identify incident disease 6 , 9 – 12 , and PPV has not been reported in the few studies regarding PCI and CABG. 10 , 12 – 14 Fourth, all previously published works in this field 4 , 13 , 15 rely exclusively upon data from hospital discharges, which may introduce a significant bias by neglecting to account for CV events documented in outpatient records.…”

Literature-Based Appraisal of Racial/Ethnic Cardiovascular Health Care Disparities

“…Blacks have a higher-risk adjusted rate of mortality after acute myocardial infarction (AMI) [14] and are 25% more likely to be readmitted within 30 days (versus Whites) when receiving care at hospitals that primarily serve nonminorities [15]. The evidence is more limited and mixed for Hispanics, Asians, and American Indians [9,16]. Only one identified study included American Indians and Alaskan Natives (AIAN) and the findings showed similar care for AIAN compared to Whites in California hospitals.…”

“…Only one identified study included American Indians and Alaskan Natives (AIAN) and the findings showed similar care for AIAN compared to Whites in California hospitals. However, this paper was a response to findings of significant disparities in other parts of the country between AIAN and Whites [16]. Without more evidence, conclusions cannot be drawn regarding disparities for groups other than Blacks.…”

Diabetes care and outcomes for American Indians and Alaska natives in commercial integrated delivery systems: a SUrveillance, PREvention, and ManagEment of Diabetes Mellitus (SUPREME-DM) Study

“…3 Cardiovascular disease (CVD), which is strongly associated with diabetes, also is increasingly common in the AI/AN population. 4 5 The costs of caring for diabetes and its complications are high; a recent study revealed that in one of the Indian Health Services’ (IHS) major facilities, 10.9% of its patients with diabetes consumed nearly 38% of the total dollars available to meet the health needs of its entire user population. 6 …”