Black patients’ health care disparity
Black patients hospitalized with a common cardiovascular condition that can lead to stroke are 25% less likely to be prescribed potentially lifesaving medication, according to a new study that raises “disconcerting” questions about racial inequity in health care, its lead author said.
The study found that Black patients hospitalized with atrial fibrillation, the most common cardiovascular rhythm disorder in the world, are 25% less likely to receive oral anticoagulants or blood thinners that prevent stroke and are 25% less likely to be discharged on blood thinners than white patients, the study shows.
“One of the bigger findings we saw is that Black patients had a two times higher risk of death if they were not discharged on these medications,” said Dr. Utibe Essien, the lead author of the study and assistant professor of medicine at the University of Pittsburgh. “So this just isn’t an important medication they give a patient because it makes our quality outcomes look good, it’s really a life-or-death matter.”
Released Thursday and presented for the first time Saturday at the Heart Rhythm Society’s annual conference at San Francisco’s Moscone Center, the study reviewed hospitalized atrial fibrillation patients from 2014 through 2020, a cohort that included about 70,000 patients from 159 hospitals across the country, Essien said.
Patients with atrial fibrillation, an irregular heart rhythm disorder that causes fluttering of the heart, are five times more likely to be at risk of stroke. Blood thinners are the standard medication prescribed to people with atrial fibrillation who are risk of developing a stroke, Essien said.
The condition impacts up to 6 million people in the United States, he said.
While Black people with atrial fibrillation have a two-time higher risk of stroke and twotime higher risk of death, they are 25% less likely to receive stroke-preventing medication, researchers said.
Black people are also less likely to be prescribed newer, more effective medications that treat the condition, called direct oral anticoagulants, Essien said.
Even when researchers adjusted the data to weigh factors such as medical history, insurance type, income, employment, education level and hospital, Black patients were still less likely to be prescribed the potentially life-saving medication.
“The racial differences really persisted even with those factors in our models, which really gets us to try to push and understand to go, ‘OK, what really is happening in our patient conversations with their doctors that’s making these prescribing differences happen?’ ” Essien said, adding that interviewing patients and doctors is the crucial next step to understanding the disparities. “There must be something else that we’re just not capturing in our data.”
Essien, a health disparities researcher whose work focuses on cardiovascular disparities, said the results of the study is “disconcerting” and reiterated similar findings in his reviews of Medicare and Veterans Affairs health care: that there are inconsistencies in the access to medications that otherwise should be equally accessible despite a person’s race and ethnicity.
Health care equity has “come to the forefront of our society” in the past two years, Essien said, referring to the coronavirus pandemic that just exacerbated long-existing racial and ethnic disparities in the health care system.
“The goal is really going to be reliant not just on these social class factors that we love to put our hat on, but really start to get at some of the issues around structural racism and bias that could be potentially explaining some of these disparities that we’re seeing,” Essien said.
In addition to Essien, researchers from Stanford University, Northwestern University, Boston University, UCLA and the Duke Cardiovascular Research Center — which helped support the study — also co-wrote the study.