Racial Disparities Among Older Adults with Acute Myocardial Infarction: The SILVER-AMI Study

Overview

Journal J Am Geriatr Soc

Specialty Geriatrics

Date 2022 Nov 23

PMID 36415964

Authors

Patrick C Demkowicz

Alexandra M Hajduk

John A Dodson

Carol R Oladele

Sarwat I Chaudhry

Affiliations

Soon will be listed here.

Abstract

Background: Despite an aging population, little is known about racial disparities in aging-specific functional impairments and mortality among older adults hospitalized for acute myocardial infarction (AMI).

Methods: We analyzed data from patients aged 75 years or older who were hospitalized for AMI at 94 US hospitals from 2013 to 2016. Functional impairments and geriatric conditions were assessed in-person during the AMI hospitalization. The association between race and risk of mortality (primary outcome) was evaluated with logistic regression adjusted sequentially for age, clinical characteristics, and measures of functional impairment and other conditions associated with aging.

Results: Among 2918 participants, 2668 (91.4%) self-identified as White and 250 (8.6%) as Black. Black participants were younger (80.8 vs 81.7 years; p = 0.010) and more likely to be female (64.8% vs 42.5%; p < 0.001). Black participants were more likely to present with impairments in cognition (37.6% vs 14.5%; p < 0.001), mobility (66.0% vs 54.6%; p < 0.001) and vision (50.1% vs 35.7%; p < 0.001). Black participants were also more likely to report a disability in one or more activities of daily living (22.4% vs 13.0%; p < 0.001) and an unintentional loss of more than 10 lbs in the year prior to hospitalization (37.2% vs 13.0%; p < 0.001). The unadjusted odds of 6-month mortality among Black participants (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.4-2.8) attenuated to non-significance after adjustment for age, clinical characteristics (OR 1.70, 95% CI 1.7, 1.2-2.5), and functional/geriatric conditions (OR 1.5, 95% CI 1.0-2.2).

Conclusions: Black participants had a more geriatric phenotype despite a younger average age, with more functional impairments. Controlling for functional impairments and geriatric conditions attenuated disparities in 6-month mortality somewhat. These findings highlight the importance of systematically assessing functional impairment during hospitalization and also ensuring equitable access to community programs to support post-AMI recovery among Black older adults.

References

Ware Jr J, Kosinski M, Keller S . A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996; 34(3):220-33. DOI: 10.1097/00005650-199603000-00003. View

Dodson J, Hajduk A, Geda M, Krumholz H, Murphy T, Tsang S . Predicting 6-Month Mortality for Older Adults Hospitalized With Acute Myocardial Infarction: A Cohort Study. Ann Intern Med. 2019; 172(1):12-21. PMC: 7695040. DOI: 10.7326/M19-0974. View

Viccaro L, Perera S, Studenski S . Is timed up and go better than gait speed in predicting health, function, and falls in older adults?. J Am Geriatr Soc. 2011; 59(5):887-92. PMC: 3522463. DOI: 10.1111/j.1532-5415.2011.03336.x. View

Wang C, Chen L . Grip strength in older adults: test-retest reliability and cutoff for subjective weakness of using the hands in heavy tasks. Arch Phys Med Rehabil. 2010; 91(11):1747-51. DOI: 10.1016/j.apmr.2010.07.225. View

Katz S . Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc. 1983; 31(12):721-7. DOI: 10.1111/j.1532-5415.1983.tb03391.x. View

Rantanen T, Guralnik J, Foley D, Masaki K, Leveille S, Curb J . Midlife hand grip strength as a predictor of old age disability. JAMA. 1999; 281(6):558-60. DOI: 10.1001/jama.281.6.558. View

Geronimus A, Hicken M, Keene D, Bound J . "Weathering" and age patterns of allostatic load scores among blacks and whites in the United States. Am J Public Health. 2005; 96(5):826-33. PMC: 1470581. DOI: 10.2105/AJPH.2004.060749. View

Aubert C, Folly A, Mancinetti M, Hayoz D, Donze J . Performance-based functional impairment and readmission and death: a prospective study. BMJ Open. 2017; 7(6):e016207. PMC: 5726050. DOI: 10.1136/bmjopen-2017-016207. View

Slopen N, Lewis T, Gruenewald T, Mujahid M, Ryff C, Albert M . Early life adversity and inflammation in African Americans and whites in the midlife in the United States survey. Psychosom Med. 2010; 72(7):694-701. PMC: 2939196. DOI: 10.1097/PSY.0b013e3181e9c16f. View

10.

Fotteler M, Muhlbauer V, Brefka S, Mayer S, Kohn B, Holl F . The Effectiveness of Assistive Technologies for Older Adults and the Influence of Frailty: Systematic Literature Review of Randomized Controlled Trials. JMIR Aging. 2022; 5(2):e31916. PMC: 9016506. DOI: 10.2196/31916. View

11.

Bindman A, Cox D . Changes in Health Care Costs and Mortality Associated With Transitional Care Management Services After a Discharge Among Medicare Beneficiaries. JAMA Intern Med. 2018; 178(9):1165-1171. PMC: 6583218. DOI: 10.1001/jamainternmed.2018.2572. View

12.

Chen L, Nallamothu B, Spertus J, Tang Y, Chan P . Racial Differences in Long-Term Outcomes Among Older Survivors of In-Hospital Cardiac Arrest. Circulation. 2018; 138(16):1643-1650. DOI: 10.1161/CIRCULATIONAHA.117.033211. View

13.

OKeefe E, Meltzer J, Bethea T . Health disparities and cancer: racial disparities in cancer mortality in the United States, 2000-2010. Front Public Health. 2015; 3:51. PMC: 4398881. DOI: 10.3389/fpubh.2015.00051. View

14.

Jeste D, Palmer B, Appelbaum P, Golshan S, Glorioso D, Dunn L . A new brief instrument for assessing decisional capacity for clinical research. Arch Gen Psychiatry. 2007; 64(8):966-74. DOI: 10.1001/archpsyc.64.8.966. View

15.

Usher T, Buta B, Thorpe R, Huang J, Samuel L, Kasper J . Dissecting the Racial/Ethnic Disparity in Frailty in a Nationally Representative Cohort Study with Respect to Health, Income, and Measurement. J Gerontol A Biol Sci Med Sci. 2020; 76(1):69-76. PMC: 7756712. DOI: 10.1093/gerona/glaa061. View

16.

Szanton S, Leff B, Wolff J, Roberts L, Gitlin L . Home-Based Care Program Reduces Disability And Promotes Aging In Place. Health Aff (Millwood). 2016; 35(9):1558-63. DOI: 10.1377/hlthaff.2016.0140. View

17.

Pandey A, Keshvani N, Khera R, Lu D, Vaduganathan M, Joynt Maddox K . Temporal Trends in Racial Differences in 30-Day Readmission and Mortality Rates After Acute Myocardial Infarction Among Medicare Beneficiaries. JAMA Cardiol. 2020; 5(2):136-145. PMC: 6990949. DOI: 10.1001/jamacardio.2019.4845. View

18.

Gruenewald T, Seeman T, Karlamangla A, Sarkisian C . Allostatic load and frailty in older adults. J Am Geriatr Soc. 2009; 57(9):1525-31. PMC: 3650612. DOI: 10.1111/j.1532-5415.2009.02389.x. View

19.

Bandeen-Roche K, Seplaki C, Huang J, Buta B, Kalyani R, Varadhan R . Frailty in Older Adults: A Nationally Representative Profile in the United States. J Gerontol A Biol Sci Med Sci. 2015; 70(11):1427-34. PMC: 4723664. DOI: 10.1093/gerona/glv133. View

20.

Green Y, Hajduk A, Song X, Krumholz H, Sinha S, Chaudhry S . Usefulness of Social Support in Older Adults After Hospitalization for Acute Myocardial Infarction (from the SILVER-AMI Study). Am J Cardiol. 2019; 125(3):313-319. PMC: 7003680. DOI: 10.1016/j.amjcard.2019.10.038. View