Race, sex, poverty, and the medical treatment of acute myocardial infarction in the elderly

Background-Race, sex, and poverty are associated with the use of diagnostic cardiac catheterization and coronary revascularization during treatment of acute myocardial infarction (AMI). However, the association of sociodemogr aphic characteristics with the use of less costly, mon readily available me dical therapies remains poorly characterized. Methods and Results-We evalua ted 169 079 Medicare beneficiaries greater than or equal to 65 years of age treated for AMI between January 1994 and February 1996 to determine the as sociation of patient race, sex, and poverty with the use of medical therapy . Multivariable regression models were constructed to evaluate the unadjust ed and adjusted influence of sociodemographic characteristics on the use of 2 admission (aspirin, reperfusion) and 2 discharge therapies (aspirin, P-b lockers) indicated during the treatment of AMI. Therapy use varied by patie nt race, sex, and poverty status. Black patients were less likely to underg o reperfusion (RR 0.84, 95% CI 0.78: 0.91) or receive aspirin on admission (RR 0.97, 95% CI 0.96, 0.99) and beta-blockers (RR 0.94, 95% CI 0.88, 1.00) at discharge. Female patients were less likely to receive aspirin on admis sion (RR 0.98, 95% CI 0.97, 0.99) and discharge (RR 0.98, 95% CI 0.96, 0.99 ). Poor patients were less Likely to receive aspirin (RR 0.97, 95% CI 0.96, 0.98) or reperfusion (RR 0.97, 95% CI 0.93, 1.00) on admission and aspirin (RR 0.98, 95% CI 0.96, 1.00), or beta-blockers (RR 0.95, 95% CI 0.91, 0.99 ) on discharge. Conclusions-Medical therapies are currently underused in th e treatment of black, female, and poor patients with AMI.