Division of Social Epidemiology, Morehouse School of Medicine, Atlanta, GA, USA

PURPOSE: The objective of this retrospective analysis was to compare secular changes in the rate of emergency room admissions (per 100,000) for selected acknowledged preventable cardiovascular conditions among African Americans (AA) men and women aged >/=21 from 1991-1998, and rate of change for Caucasian (Cau), Hispanic (Hisp), and Asian (Asi) men and women aged >/=21; conditions included angina, congestive heart failure (CHF), diabetes, and hypertension.
METHODS: Results are derived from calendar-year California hospital data based on a selection of specified ICD-9 codes that correspond to the principal diagnosis for admission. The combined study sample size included a total of 21,016 individuals who were admitted to a hospital via the ER. Separate standardized and age-adjusted Poisson regression models were employed for each condition to assess race and time main effects and race x time interaction terms (P </= 0.01). Age and payer-source were entered as covariates to control for confounding effects. Men and women were analyzed separately.
RESULTS: Mean overall rates of ER admission due to angina were significantly lower among AA men compared to Cau men (17.8 vs 18.2); however, rates were higher among Hisp and Asi men (6.03 and 7.1, respectively). Rates for CHF were higher among AA men compared to Cau, Hisp, and Asi men (23.7 vs, 11.0, 3.7, 4.8, respectively); similar results were observed for diabetes (8.6 vs 2.7, 2.3, 1.2, respectively) and hypertension (5.1 vs, 1.6, 0.9, 1.5, respectively). Differentials in 1991 resulted in widening disparities overtime for each condition. For women, mean overall rates due to angina were significantly higher among AA women compared Cau, Hisp, and Asi women (17.0 vs 13.5, 5.7, 5.7, respectively). Similar patterns were observed for CHF (23.1 vs, 11.0, 3.7, 4.8, respectively), diabetes (6.4 vs 2.0, 1.8, 1.1, respectively) and hypertension (5.8 vs 1.9, 1.1, 1.5), respectively). As observed among AA men, differentials in 1991 resulted in widening disparity overtime.
CONCLUSIONS: Findings reveal higher rates of ER admissions for preventable cardiovascular conditions among AA men and women during the 1990s with evidence of widening health status disparities into the new millennium.

PMID: 11018371 [PubMed - as supplied by publisher]