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Women, black adults face greater loss of life expectancy after MI
After an acute MI, black patients lost more of their expected life years than white patients, and women lost more of their expected life years than men, researchers reported in a new study.
Differences in clinical presentation and treatment explained the racial discrepancy, but not the difference between men and women.
The researchers analyzed records on 146,743 patients (mean age, 76 years; 48% women; 6.4% black) from the Cooperative Cardiovascular Project, a study of Medicare beneficiaries admitted to a hospital for acute MI in 1994 and 1995. Based on those records, they calculated life expectancy and years of potential life lost for each patient, and analyzed the rates by race and sex.
Emily Bucholz
“Recognizing that women in the general population live longer than men, we asked the question of whether women who have a heart attack are actually at a survival disadvantage because they are losing more years of life after the event than men,” Emily Bucholz, MD, PhD, MPH, pediatric resident at Boston Children’s Hospital, said in a press release.
At 17 years, the overall survival rate was 7.3%. By sex and race, the survival rate was 8.3% for white men, 6.4% for white women, 5.4% for black men and 5.8% for black women, according to the researchers. After acute MI, men and women of the same race had similar life expectancy at any age, but black adults had lower life expectancy at younger ages compared with white adults at younger ages, although the difference disappeared at older ages, the researchers reported.
Expected life loss
Compared with men, women lost 10.5% more of their expected life. Compared with white adults, black adults lost 6.2% more of their expected life, according to results of an unadjusted analysis.
After adjustment for demographics, medical history, clinical presentation and treatment, the researchers determined that women lost 7.8% more of their expected life compared with men, but black adults lost 3.5% less of their expected life than white adults. The effect of black race was most impacted by adjustment for diabetes, congestive HF, clinical presentation and revascularization, according to the researchers.
Harlan M. Krumholz
“We found that women and black patients are losing more years of their life after a heart attack with one of the reasons potentially being that they are not receiving care on par with men and white patients,” Harlan M. Krumholz, MD, SM, FACC, director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation, said in the release. “The study makes clear the disadvantage of these groups and suggests that higher quality of care for everyone might be a helpful remedy.”
Life expectancy estimates
In a related editorial, Jack V. Tu, MD, PhD, from the Institute for Clinical Evaluative Sciences, Sunnybrook Schulich Heart Centre, and the University of Toronto, Toronto, noted that the “analyses reinforce the need to improve the clinical presentation and treatment of all [acute MI] patients, but especially those of black race.”
According to Tu, “accurate life expectancy estimates would also prove invaluable to clinicians in making decisions about the use of life-extending therapies in high-risk patients.” – by Erik Swain
Disclosures: Bucholz and Tu report no relevant financial disclosures. Krumholz reports receiving research agreements from Johnson & Johnson and Medtronic via his institution, working under contract with the CMS and chairing an advisory board for United Health. Another researcher reports serving on the board of directors for Frontier Science and Technology.