RT Journal
A1 Bradley EH, Herrin J, Wang Y, et al
T1 RAcial and ethnic differences in time to acute reperfusion therapy for patients hospitalized with myocardial infarction
JF JAMA
JO JAMA
YR 2004
FD October 6
VO 292
IS 13
SP 1563
OP 1572
DO 10.1001/jama.292.13.1563
UL http://dx.doi.org/10.1001/jama.292.13.1563
AB Context 
                  Nonwhite patients experience significantly longer times to fibrinolytic
therapy (door-to-drug times) and percutaneous coronary intervention (door-to-balloon
times) than white patients, raising concerns of health care disparities, but
the reasons for these patterns are poorly understood.Objectives 
                  To estimate race/ethnicity differences in door-to-drug and door-to-balloon
times for patients receiving primary reperfusion for ST-segment elevation
myocardial infarction; to examine how sociodemographic factors, insurance
status, clinical characteristics, and hospital features mediate racial/ethnic
differences.Design, Setting, and Patients 
                  Retrospective, observational study using admission and treatment data
from the National Registry of Myocardial Infarction (NRMI) for a US cohort
of patients with ST-segment elevation myocardial infarction or left bundle-branch
block and receiving reperfusion therapy. Patients (73 032 receiving
fibrinolytic therapy; 37 143 receiving primary percutaneous coronary
intervention) were admitted from January 1, 1999, through December 31, 2002,
to hospitals participating in NRMI 3 and 4.Main Outcome Measure 
                  Minutes between hospital arrival and acute reperfusion therapy.Results 
                  Door-to-drug times were significantly longer for patients identified
as African American/black (41.1 minutes), Hispanic (36.1 minutes), and Asian/Pacific
Islander (37.4 minutes), compared with patients identified as white (33.8
minutes) (P<.01 for all). Door-to-balloon times
for patients identified as African American/black (122.3 minutes) or Hispanic
(114.8 minutes) were significantly longer than for patients identified as
white (103.4 minutes) (P<.001 for both). Racial/ethnic
differences were still significant but were substantially reduced after accounting
for differences in mean times to treatment for the hospitals in which patients
were treated; significant racial/ethnic differences persisted after further
adjustment for sociodemographic characteristics, insurance status, and clinical
and hospital characteristics (P<.01 for all).Conclusion 
                  A substantial portion of the racial/ethnic disparity in time to treatment
was accounted for by the specific hospital to which patients were admitted,
in contrast to differential treatment by race/ethnicity inside the hospital.