Study Finds Sex and Race Disparities in Life Expectancy After MI
After acute myocardial infarction (AMI), women and black patients lose more years of their expected life when compared to white men, according to a study published Aug. 3 in the Journal of the American College of Cardiology.
Previous research has shown sex and racial differences in survival after myocardial infarction, but this was the first study to account for women’s longer life expectancy in the general population and the shorter life expectancy of blacks.
Researchers examined data from the Cooperative Cardiovascular Project, a prospective cohort study that includes all fee-for-service Medicare beneficiaries discharged from acute-care non-governmental U.S. hospitals with AMI in the mid-1990s. They reviewed records from 146,743 patients with AMI; 48.1 percent were women and 6.4 percent were black. Women and black patients had a higher prevalence of diabetes, hypertension and heart failure compared with white men.
After the 17-year follow-up period, the survival rate was 8.3 percent for white men, 6.4 percent for white women, 5.4 percent for black men and 5.8 percent for black women. Men and women of the same race had similar life expectancy after AMI at all ages and only minimal differences by sex were observed in the youngest and oldest ages. However, when adjusting for differences in expected survival, women lost significantly more years of life than men of the same race. The researchers estimated that, on average, a 65-year-old white man loses 5.1 years of life after AMI and a white woman loses 10 years, translating to a 29 percent reduction in remaining life for men and a 41 percent reduction for women.
Results also showed that black patients had lower life expectancies after AMI. Black men lost 0.3 more years than white men and black women lost one more year of life than white women, equating to black patients losing 5 percent more time lost than white patients. The researchers note that racial differences in disease burden can be explained by differences in comorbidities and treatment utilization, which was not the case for women. After adjusting for differences in clinical presentation and treatment, women still lost more of their expected life than men.
According to the authors, these findings demonstrate the importance of secondary prevention in women and black patients, and highlight the importance of national efforts to ensure equitable delivery of care.
“It is imperative that we understand whether disparities we observe in a specific group, like people with myocardial infarction, is particular to them or more broadly reflective of the experience in the population,” said Harlan Krumholz, MD, SM, FACC, senior study author and director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation. “We found that women and black patients are losing more years of their life after a myocardial infarction with one of the reasons potentially being they are not receiving care on par with men and white patients. The study makes clear the disadvantage of these groups and suggests that higher quality of care for everyone might be a helpful remedy.”
In a corresponding editorial comment, Jack V. Tu, MD, PhD, of the Institute for Clinical Evaluative Sciences, in Toronto, Ontario, Canada, notes that the analyses “reinforce the need to improve the clinical presentation and treatment of all AMI patients but especially those of black race. They also demonstrate that the sex differences in years of potential life lost are primarily due to differences in life expectancy in the general population rather than in the post-AMI population.”
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