Are people treated differently because of their race or ethnicity?
Yes. Except in rare cases, everyone should receive the same therapies for preventing and treating heart disease regardless of their race or ethnicity. Unfortunately, minority groups do tend to receive poorer cardiac care. In one study of more than 38,000 white and over 5,500 black patients who had had a heart attack, black patients were less likely to receive therapies like statin drugs to lower cholesterol. They were also less likely to receive treatments such as balloon angioplasty to unblock arteries, stents to prop open unblocked arteries, bypass surgery, or advice on how to quit smoking.36
In an all-female study, African-American women were less likely to receive appropriate preventive care, such as aspirin or cholesterol-lowering statin medications (e.g., Lipitor). They also didn't receive treatment or counseling on how to get their risk factors such as weight or smoking under control despite having a greater risk of a heart attack.21
In one study of 700,000 elderly Medicare beneficiaries with heart disease, African Americans and Native Americans underwent invasive diagnostic and surgical procedures far less often than whites, and Asian Americans were 50% less likely to be admitted to a hospital than whites.37 Several studies of heart attack patients have shown that African Americans, Asian Americans, and Hispanics are less likely than whites to undergo procedures to unclog their arteries.38-45
Does race and ethnicity affect how quickly a person gets treated?
Yes. Minority patients often wait longer for treatment. A 2004 study found significant racial differences in the time between arriving at the hospital and receiving treatment to unblock clogged arteries. For clot-busting drugs, African-American patients waited an average of 41 minutes, Asians/Pacific Islanders waited 37 minutes, and Hispanics waited 36 minutes compared with whites, who waited 34 minutes.46
Are there racial and ethnic differences at different treatment centers?
Yes. Several studies have shown that the hospital itself accounts for a significant proportion of health disparities. One study showed that black patients were consistently treated at poorer-quality facilities than white patients. Black patients were more likely to undergo bypass surgery at hospitals with the highest mortality rates and at hospitals that had less experience performing the procedure. 42
What is race-based medicine?
The idea for race-based medicine comes from the observation that some medications may not work the same way in different racial or ethnic groups. These differences may be due to genetic factors that affect both how the drugs are processed in the body and the nature of a person's heart disease.47
The heart failure drug BiDil recently became the first drug specifically designated by the FDA for use in a single racial or ethnic group (African Americans), though this decision is controversial.48, 49 Some scientists believe that the studies on BiDil did not do an effective comparison of the drug's effects in different racial groups. Your ancestry should never be the only reason for a particular treatment. You should never be denied treatment on the basis of your race or ethnicity.
While racial and ethnic disparities still exist, deaths from heart disease and stroke are decreasing in all races.50 It is clear that when evidence-based treatments are given equally to all people, many of the health disparities disappear.
For more information:
Why the Difference? An Initiative on Racial/Ethnic Disparities in Medical Care
http://www.kff.org/whythedifference/index.htm
U.S. Department of Health & Human Services Office of Minority Health
http://www.omhrc.gov/
Office of Minority Health
http://www.cdc.gov/omh/AboutUs/disparities.htm
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