Older Black adults with acute MI more likely to present with ‘geriatric’ phenotype
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Among adults hospitalized with acute MI, Black patients presented with a more “geriatric” phenotype with more functional impairments than white patients despite being younger, researchers reported.
In an analysis of older adults hospitalized with acute MI, researchers also found that older Black patients had higher rates of 6-month mortality, which were attenuated after inclusion of functional impairments and other conditions associated with aging.
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“In general, however, measures of physical and cognitive functional impairment are rarely included in studies of health disparities,” Patrick C. Demkowicz, BS, of the department of internal medicine at Yale University School of Medicine, and colleagues wrote in the Journal of the American Geriatrics Society. “Our study reinforces the importance of including these measures to understand racial disparities and builds upon prior work by focusing on older adults aged 75 and older at the time of hospitalization for acute MI.”
Demkowicz and colleagues analyzed data from 2,918 adults aged 75 years and older hospitalized for acute MI at 94 U.S. hospitals from 2013 to 2016. Within the cohort, 91.4% were white and 8.6% were Black. Clinicians assessed functional impairments and geriatric conditions in-person during the hospitalization. Researchers evaluated the association between race and mortality risk, adjusted sequentially for age, clinical characteristics and measures of functional impairment and other conditions associated with aging.
Compared with white patients, Black patients were younger (mean age, 80.8 years vs. 81.7 years; P = .01) and more likely to be women (64.8% vs. 42.5%; P < .001).
Researchers found that, compared with white patients, Black patients were more likely to present with impairments in cognition (37.6% vs. 14.5%; P < .001), mobility (66% vs. 54.6%; P < .001) and vision (50.1% vs. 35.7%; P < .001). Black participants were also more likely to report a disability in one or more activities of daily living (22.4% vs. 13%; P < .001) and an unintentional loss of more than 10 lb in the year before hospitalization (37.2% vs. 13%; P < .001) compared with white patients.
In unadjusted analyses, Black patients were twice as likely to die in the 6 months after hospitalization than white patients (OR = 2; 95% CI, 1.4-2.8); however, this was attenuated after adjustment for age and clinical characteristics (OR = 1.7; 95% CI, 1.2-2.5) and functional/geriatric conditions (OR = 1.5; 95% CI, 1-2.2).
“Recognizing preexisting disparities in access to services such as home health care, further attention is needed to develop and implement post-hospital care programs that address the specific needs of older Black patients,” the researchers wrote.
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