Do Gender and Race/Ethnicity Influence Acute Myocardial Infarction Quality of Care in a Hospital with a Large Hispanic Patient and Provider Representation?

Background. Disparities in acute myocardial infarction (AMI) care for women and minorities have been extensively reported in United States but with limited information on Hispanics. Methods. Medical records of 287 (62%) Hispanic and 176 (38%) non-Hispanic white (NHW) patients and 245 women (53%) admitted with suspected AMI to a southern California nonprofit community hospital with a large Hispanic patient and provider representation were reviewed. Baseline characteristics, outcomes (mortality, CATH, PCI, CABG, and use of pertinent drug therapy), and medical insurance were analyzed according to gender, Hispanic and NHW race/ethnicity when AMI was confirmed. For categorical variables, 2×2 chi-square analysis was conducted. Odds ratio and 95% confidence interval for outcomes adjusted for gender, race/ethnicity, cardiovascular risk factors, and insurance were obtained. Results. Women and Hispanics had similar drug therapy, CATH, PCI, and mortality as men and NHW when AMI was confirmed (n=387). Hispanics had less private insurance than NHW (31.4% versus 56.3%, P<0.001); no significant differences were found according to gender. Conclusions. No differences in quality measures and outcomes were found for women and between Hispanic and NHW in AMI patients admitted to a facility with a large Hispanic representation. Disparities in medical insurance showed no influence on these findings

Women's Education Level, Maternal Health Facilities, Abortion Legislation and Maternal Deaths: A Natural Experiment in Chile from 1957 to 2007

The aim of this study was to assess the main factors related to maternal mortality reduction in large time series available in Chile in context of the United Nations' Millennium Development Goals (MDGs).Time series of maternal mortality ratio (MMR) from official data (National Institute of Statistics, 1957-2007) along with parallel time series of education years, income per capita, fertility rate (TFR), birth order, clean water, sanitary sewer, and delivery by skilled attendants were analysed using autoregressive models (ARIMA). Historical changes on the mortality trend including the effect of different educational and maternal health policies implemented in 1965, and legislation that prohibited abortion in 1989 were assessed utilizing segmented regression techniques.During the 50-year study period, the MMR decreased from 293.7 to 18.2/100,000 live births, a decrease of 93.8%. Women's education level modulated the effects of TFR, birth order, delivery by skilled attendants, clean water, and sanitary sewer access. In the fully adjusted model, for every additional year of maternal education there was a corresponding decrease in the MMR of 29.3/100,000 live births. A rapid phase of decline between 1965 and 1981 (-13.29/100,000 live births each year) and a slow phase between 1981 and 2007 (-1.59/100,000 live births each year) were identified. After abortion was prohibited, the MMR decreased from 41.3 to 12.7 per 100,000 live births (-69.2%). The slope of the MMR did not appear to be altered by the change in abortion law.Increasing education level appears to favourably impact the downward trend in the MMR, modulating other key factors such as access and utilization of maternal health facilities, changes in women's reproductive behaviour and improvements of the sanitary system. Consequently, different MDGs can act synergistically to improve maternal health. The reduction in the MMR is not related to the legal status of abortion

Changing Trends in the Prevalence and Disparities of Obesity and Other Cardiovascular Disease Risk Factors in Three Racial/Ethnic Groups of USA Adults

Objectives. To examine trends in the prevalence and disparities of traditional cardiovascular disease (CVD) risk factors among the major race/ethnic groups in the USA: non-Hispanic Whites (NHWs), non-Hispanic Blacks (NHBs), and Mexican Americans (MAs). Methods. We used cross-sectional trend analysis in women and men aged 25–84 years participating in the NHANES surveys, years 1988–1994 (n=14,341) and 1999–2004 (n=12,360). Results. The prevalence of obesity and hypertension increased significantly in NHW and NHB, both in men and women; NHB had the highest prevalence of obesity and hypertension in each time period. Diabetes prevalence showed a nonsignificant increasing trend in all groups and was higher in MA in both periods. Smoking significantly decreased in NHW men and NHB, the latter with the largest decline although the highest prevalence in each period; no changes were noted in MA, who had the lowest prevalence in both periods. Race/ethnic CVD risk factors disparities widened for obesity and hypercholesterolemia, remained unchanged for diabetes and hypertension, and narrowed for smoking. Conclusions. The increasing prevalence of obesity and hypertension underscores the need for better preventive measures, particularly in the NHB group that exhibits the worst trends. The decline in smoking rates may offset some of these unfavorable trends

Slopes of different segments observed in the trend of the maternal mortality ratio between 1957 and 2007.

<p>The slopes for the periods 1981 to 2003 and 1989 to 2003 were parallel and no statistical difference was detected in β-coefficients.</p

Trend for abortion mortality ratio (AMR), Chile 1957–2007.

<p>The highest AMR was observed in 1961, with 95.1 per 100,000 live births decreasing to 0.83 per 100,000 live births in 2007. This represented an accumulated reduction of 99.1%. The best estimated curve for the total trend over time was exponential with a goodness-of-fit of 93.5% (secondary chart). In 1989, the year of abortion prohibition, AMR was 10.78 per 100,000 live births. The accumulated decrease for the period between 1989 and 2007 was −9.95 per 100,000 live births (a reduction of 92.3% from 1989).</p

Segmented regression models assessing different join points in the time series of the maternal mortality ratio from 1957 to 2007 in Chile.

<p>Segmented regression models assessing different join points in the time series of the maternal mortality ratio from 1957 to 2007 in Chile.</p

Pathway modelling using autoregressive integrated moving average (ARIMA) models for assessing the different predictors of the maternal mortality ratio in a time series from 1957 to 2007 in Chile.

<p>β is the regression coefficient or the estimate of the average change in the maternal mortality ratio per 100,000 live births per unit of change in the independent variable. GDI (Gross Domestic Income) refers to the Gross Domestic Product per 1,000 US dollars. The pathway modelling approach is as follows: Model 1 adjusted for the initial slope in 1957; Model 2 is Model 1 adjusted for the average number of schooling years; Model 3 is Model 2 additionally adjusted for the join point and the slope for the segment from 1965; and Model 4 is Model 3 adjusted for the join point and the slope for the segment from 1981.</p

Trend for maternal mortality ratio, Chile 1957–2007.

<p>The secondary graphic shows the best adjustment of total trend for Maternal Mortality Ratio (MMR) over time.</p

Parallel time series of the co-variables assessed in the study on maternal mortality in Chile from 1957 to 2007.

†<p>Average of schooling years for women in economically active age.</p