DISPARITIES IN ACCESS TO CARDIAC CARE AMONG BALTIMORE CITY PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Abstract

Every year, approximately 600,000 people die of heart disease and roughly 720,000 people have a heart attack in the United States. It is still the leading cause of death in the nation across gender, racial and ethnic groups. In Maryland, the mortality rate for heart disease has decreased by 28.8 percent in the past decade. However, disparities in the mortality rate and utilization of cardiac care still persist by race, gender, insurance status, and location (Chen, Mann, & Hussein, 2012).

Baltimore City has one of the highest percentages of African American residents in the State of Maryland having experienced little or no improvement in terms of their health status. In 2010, the Baltimore City Health Department released the city’s first Health Disparities Report Card, a comprehensive health assessment of various health indicators, such as heart disease, cancer, diabetes, infant mortality, and obesity. The overall final grade for the city was a D. This report clearly reaffirmed the persistent health disparities among racial and ethnic groups, particularly African Americans. Compared with whites, they fared worse on 21 out of 29 health indicators (Baltimore City Health Department, 2010).

The purpose of this study is to determine whether, among Baltimore City residents, there are differences in access to cardiac care based on sociodemographic characteristics. This care entails undergoing invasive cardiac procedures for treating coronary heart disease (CHD), specifically acute myocardial infarction (AMI), more commonly known as heart attacks. The sociodemographic characteristics include race, gender, insurance status based on primary payer, and jurisdiction based on place of residence. To gain insight into the effects of sociodemographic characteristics on patients with AMI in undergoing invasive cardiac procedures, retrospective analyses were conducted of recent hospital inpatient discharge data that answer the following research questions. In Baltimore City,

1) are African American patients more or less likely than white patients to undergo invasive cardiac procedures when diagnosed with AMI?

2) what role does insurance status play among patients with AMI in receiving cardiac care?

3) how do patients with AMI compare against other Maryland patients with AMI in receiving cardiac care? Does location matter?