Clinton-era health equity initiative may have improved STEMI care and mortality
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Key takeaways:
- A 1998 federal initiative could be responsible for increased use of PCI and reduced mortality after STEMI among racial/ethnic groups.
- Crude mortality was most improved among Hispanic patients.
A Clinton-era initiative to reduce racial/ethnic health disparities may have helped to minimize inequities in PCI usage and mortality after STEMI among Black, white and Hispanic patients in New Jersey, researchers reported.
An analysis evaluating STEMI treatment and outcomes before and after the 1998 federal initiative was published in the Journal of the American Heart Association.
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“In 1998, President Clinton announced a federal initiative to reduce health disparity through the promotion of education and research. This $400 million initiative was designed to target and improve outcomes in CVD, infant mortality, cancer screening and management, diabetes, HIV/AIDS, and adult and child vaccinations by 2010 in Black, American Indian or Alaska Native, Hispanic, Asian and Pacific Islander communities,” Niharika Bhatia, MD, of the Rutgers Robert Wood Johnson Medical School in Piscataway, New Jersey, and colleagues wrote. “Limited research has been done to assess the impact of this initiative on the outcomes of STEMI in minorities.”
Using the New Jersey Myocardial Infarction Data Acquisition System, Bhatia and colleagues evaluated change in STEMI outcomes potentially associated with the 1998 federal initiative among 7,942 Black, 27,665 Hispanic and 88,727 white patients.
After adjusting for demographics, comorbidities and interventional procedures, the researchers observed an overall increase in the use of PCI in all three groups.
Before 1998, white patients received PCI more often compared with Black and Hispanic patients (P < .05), and after 1998, the disparity was greatly reduced for Black patients and the difference reversed in favor of Hispanic patients after 2005 (P < .05). The disparity in PCI between Black and white patients reemerged in 2005 (P = .01) and slightly worsened after 2010 (P < .01), according to the study.
In addition, researchers observed a downward trend for in-hospital mortality with no evidence of disparity among Black, Hispanic and white patients.
On a linear regression model, the slope of 1-year all-cause and CV mortality after STEMI was not statistically significant before 1998. After 1998, the negative slopes for mortality for all three groups were significant, with lower crude mortality for Hispanic patients compared with Black and white patients with STEMI (P < .0001), according to the study.
“In our study, we found that in patients with STEMI after the launch of the federal initiative in 1998, the disparity in the use of PCI was reduced for Black and Hispanic patients as well as the disparity in 1-year mortality,” the researchers wrote. “There was an overall downward trend in hospital mortality without evidence of disparity among Black, Hispanic and white patients. Using 1998 as the change-point, the 1-year all-cause and CVD mortality showed negative slopes for all three groups. However, the slope for Hispanic patients was statistically different compared with Black and white patients.”
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