Using Health Care Financing Administration data for patients hospitalized for acute myocardial infarction, the authors evaluated 4-year trends in survival and treatment. The 1-year mortality rates (adjusted for age and gender) did not differ between white and black patients; however the 30-day mortality rates did differ by race for each of the four years from 1987 to 1990. (In 1990 the adjusted 30-day RR for blacks compared with whites was 0.87 (95% confidence interval was 0.84 to 0.91).)

Over the 4-year period, the proportion of patients who had angiography within 90-days of their index admission increased, as did the rates of revascularization procedures, bypass surgery, and angioplasty. While the RR for angiography of blacks compared with whites rose very slightly during this period (RR in 1987=0.72, 95% confidence interval=0.69 to 0.74, and RR in 1990=0.76, 95% confidence interval=0.74 to 0.78), the rate for revascularization procedures –coronary artery bypass surgery (CABG) and percutaneous transluminal coronary angioplasty (PCTA) – remained the same. All rates revealed that blacks received these procedures about half as frequently as “non-blacks.”

Among patients undergoing angiography, the adjusted RR for having either revascularization procedure rose slightly from 0.69 (95% confidence interval=0.66 to 0.73) to 0.72 (95% confidence interval=0.69 to 0.75).

No data were provided regarding racial patterns in use of drug therapy. The overall rate of use of thrombolytic therapy rose from 4.1% to 11%, the use of beta blockers increased from 24% to 28%, and the use of calcium channel blockers decreased from 62% to 55% in the SMS Corporation administrate cohort (a similar, but smaller cohort than the cohort identified through the HCFA). However, the authors estimate that only a small part of the decline in 30-day mortality could be explained by increased use of thrombolysis and state that “other factors must surely be involved.” None were tested, however.

Improvement in survival was significant regardless of gender or race. “Although we observed continued disparities in the use of angiography and revascularization procedures…, the survival improvements in each demographic subgroup suggest that improvements are being made in the care that affect all AMI patients regardless of their gender or race.”

The authors conclude, “The fact that mortality rates for blacks and whites were similar at one-year, while revascularization procedure rates of blacks remained at about half the rates of whites, suggests that the increased use of invasive procedures may be relatively unimportant with respect to mortality decline.” They do not mention other possible confounding effects of racism.