Racial Disparities in Prescriptions for Cardioprotective Drugs and Cardiac Outcomes in Veterans Affairs Hospitals

Jawahar L. Mehta, Zoran Bursac, Paulette Mehta, Darpan Bansal, Louis Fink, James Marsh, Rishi Sukhija, Rajesh Sachdeva

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Previous reports have suggested that blacks receive life-saving cardioprotective therapies less often than whites, probably because of a lower socioeconomic status, which leads to poor access to physicians. We questioned whether racial disparity existed in the Veterans Affairs Healthcare System. We examined the Veterans' Integrated Service Network (VISN 16) database with regard to the prescription rates for 4 cardiovascular agents-aspirin, β blockers, statins, and angiotensin-converting enzyme inhibitors. The database, encompassing 474,565 patients (117,071 blacks and 357,494 whites), was analyzed. Cardioprotective drugs were prescribed significantly less often to black patients than compared to white patients (β blockers 19.7% vs 24.8%, odds ratio [OR] 0.74, 95% confidence interval [CI] 0.72 to 0.75; statins 20.5% vs 30.2%, OR 0.54, 95% CI 0.52 to 0.55; and angiotensin-converting enzyme inhibitors 27.7% vs 30.0%, OR 0.94, 95% CI 0.92 to 0.96; all p <0.0001, after adjustment for all covariates used in the analysis). Nonetheless, the prescription rates for aspirin were greater among the black patients than among the white patients (OR 1.31, 95% CI 1.27 to 1.35, p <0.001) after adjustment. The black patients received coronary artery bypass grafting less often than did the white patients (0.4% vs 1.21%, OR 0.40% to 0.48%, 95% CI 1.34 to 1.42, p <0.001). After adjustment for the use of cardioprotective drugs and coronary artery bypass grafting, black patients still had greater odds of developing angina (OR 1.38, 95% CI 1.34 to 1.42, p <0.001) and acute myocardial infarction (OR 1.11, 95% CI 1.03 to 1.19, p <0.006) than did white patients in the Department of Veterans Affairs Veterans' Integrated Service Network 16 hospitals. In conclusion, the lower prescription rates of cardioprotective drugs and lower rates of coronary artery bypass grafting might be a partial basis for the high rates of cardiac morbidity among black patients.

Original languageEnglish (US)
Pages (from-to)1019-1023
Number of pages5
JournalAmerican Journal of Cardiology
Volume105
Issue number7
DOIs
StatePublished - Apr 1 2010
Externally publishedYes

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Veterans Hospitals
Prescription Drugs
Odds Ratio
Confidence Intervals
Veterans
Coronary Artery Bypass
Prescriptions
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Angiotensin-Converting Enzyme Inhibitors
Aspirin
Pharmaceutical Preparations
Databases
Cardiovascular Agents
Social Class
Myocardial Infarction
Morbidity
Delivery of Health Care
Physicians

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Racial Disparities in Prescriptions for Cardioprotective Drugs and Cardiac Outcomes in Veterans Affairs Hospitals. / Mehta, Jawahar L.; Bursac, Zoran; Mehta, Paulette; Bansal, Darpan; Fink, Louis; Marsh, James; Sukhija, Rishi; Sachdeva, Rajesh.

In: American Journal of Cardiology, Vol. 105, No. 7, 01.04.2010, p. 1019-1023.

Research output: Contribution to journalArticle

Mehta, Jawahar L. ; Bursac, Zoran ; Mehta, Paulette ; Bansal, Darpan ; Fink, Louis ; Marsh, James ; Sukhija, Rishi ; Sachdeva, Rajesh. / Racial Disparities in Prescriptions for Cardioprotective Drugs and Cardiac Outcomes in Veterans Affairs Hospitals. In: American Journal of Cardiology. 2010 ; Vol. 105, No. 7. pp. 1019-1023.
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abstract = "Previous reports have suggested that blacks receive life-saving cardioprotective therapies less often than whites, probably because of a lower socioeconomic status, which leads to poor access to physicians. We questioned whether racial disparity existed in the Veterans Affairs Healthcare System. We examined the Veterans' Integrated Service Network (VISN 16) database with regard to the prescription rates for 4 cardiovascular agents-aspirin, β blockers, statins, and angiotensin-converting enzyme inhibitors. The database, encompassing 474,565 patients (117,071 blacks and 357,494 whites), was analyzed. Cardioprotective drugs were prescribed significantly less often to black patients than compared to white patients (β blockers 19.7{\%} vs 24.8{\%}, odds ratio [OR] 0.74, 95{\%} confidence interval [CI] 0.72 to 0.75; statins 20.5{\%} vs 30.2{\%}, OR 0.54, 95{\%} CI 0.52 to 0.55; and angiotensin-converting enzyme inhibitors 27.7{\%} vs 30.0{\%}, OR 0.94, 95{\%} CI 0.92 to 0.96; all p <0.0001, after adjustment for all covariates used in the analysis). Nonetheless, the prescription rates for aspirin were greater among the black patients than among the white patients (OR 1.31, 95{\%} CI 1.27 to 1.35, p <0.001) after adjustment. The black patients received coronary artery bypass grafting less often than did the white patients (0.4{\%} vs 1.21{\%}, OR 0.40{\%} to 0.48{\%}, 95{\%} CI 1.34 to 1.42, p <0.001). After adjustment for the use of cardioprotective drugs and coronary artery bypass grafting, black patients still had greater odds of developing angina (OR 1.38, 95{\%} CI 1.34 to 1.42, p <0.001) and acute myocardial infarction (OR 1.11, 95{\%} CI 1.03 to 1.19, p <0.006) than did white patients in the Department of Veterans Affairs Veterans' Integrated Service Network 16 hospitals. In conclusion, the lower prescription rates of cardioprotective drugs and lower rates of coronary artery bypass grafting might be a partial basis for the high rates of cardiac morbidity among black patients.",
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AU - Bansal, Darpan

AU - Fink, Louis

AU - Marsh, James

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AU - Sachdeva, Rajesh

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N2 - Previous reports have suggested that blacks receive life-saving cardioprotective therapies less often than whites, probably because of a lower socioeconomic status, which leads to poor access to physicians. We questioned whether racial disparity existed in the Veterans Affairs Healthcare System. We examined the Veterans' Integrated Service Network (VISN 16) database with regard to the prescription rates for 4 cardiovascular agents-aspirin, β blockers, statins, and angiotensin-converting enzyme inhibitors. The database, encompassing 474,565 patients (117,071 blacks and 357,494 whites), was analyzed. Cardioprotective drugs were prescribed significantly less often to black patients than compared to white patients (β blockers 19.7% vs 24.8%, odds ratio [OR] 0.74, 95% confidence interval [CI] 0.72 to 0.75; statins 20.5% vs 30.2%, OR 0.54, 95% CI 0.52 to 0.55; and angiotensin-converting enzyme inhibitors 27.7% vs 30.0%, OR 0.94, 95% CI 0.92 to 0.96; all p <0.0001, after adjustment for all covariates used in the analysis). Nonetheless, the prescription rates for aspirin were greater among the black patients than among the white patients (OR 1.31, 95% CI 1.27 to 1.35, p <0.001) after adjustment. The black patients received coronary artery bypass grafting less often than did the white patients (0.4% vs 1.21%, OR 0.40% to 0.48%, 95% CI 1.34 to 1.42, p <0.001). After adjustment for the use of cardioprotective drugs and coronary artery bypass grafting, black patients still had greater odds of developing angina (OR 1.38, 95% CI 1.34 to 1.42, p <0.001) and acute myocardial infarction (OR 1.11, 95% CI 1.03 to 1.19, p <0.006) than did white patients in the Department of Veterans Affairs Veterans' Integrated Service Network 16 hospitals. In conclusion, the lower prescription rates of cardioprotective drugs and lower rates of coronary artery bypass grafting might be a partial basis for the high rates of cardiac morbidity among black patients.

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