Jay J. Shen, PhD, Department of Health Administration, College of Health Professions, Governors State University, One University Parkway, University Park, IL 60466, (708)235-2131, j-shen@govst.edu and Elmer L. Washington, MD, Aunt Martha Youth Service Center, Inc., 233 West Jor Orr Road, Chicago Heights, IL 60411.

This study compares the magnitude of racial disparities before and after the 1997 national initiative attempting to eliminate racial disparities in health care by the year 2010. 251,000 adults with acute myocardial infarction (AMI) and 662,000 patients with pneumonia were identified from the 1995, 1998 and 2001 National Inpatient Sample. Since AMI outcomes are primarily influenced by inpatient and emergency department (ED) care while pneumonia outcomes are primarily influenced by access to outpatient care, studying both conditions provides complimentary perspectives. 80% of patients were white, 11% African American (AA), 7% Hispanic, and 2% Asian/Pacific Islander. For AMI, compared to whites, an initial lower probability among Hispanics disappeared (risk ratios (RR), 0.79 in 1995 and 1.01 [95% confidence interval (CI)], [0.98, 1.04]) in 2001); the gap of both AAs and Hispanics with whites in receiving angioplasty decreased (RR 0.68 in 1995 and 0.80 in 2001 for AAs and 0.84 and 0.90 for Hispanics). AAs were less likely to receive CABG but the gap was narrowed (RR, 0.57 and 0.69 in 1995 and 2001), Hispanics were less likely to receive CABG in 1995 (RR, 0.74) but became more likely to receive the procedure in 2001 (RR, 1.13). Asians became more likely to receive CABG in 2001 (RR, 1.14); the higher probability of having complications for Asians slightly increased (RR, 1.05 and 1.11 in 1995 and 2001). While there were no disparities in mortality between minorities and whites in 1995, higher mortality risk of minorities was observed in 2001 (RR, 1.09, 1.13 and 1.27 for AAs, Hispanics and Asians). For pneumonia, only African Americans were more likely to be admitted through the ED than whites (RR, 1.11 and 1.08 in 1995 and 2001). There was little discrepancy in probabilities of receiving mechanical ventilation across the four racial subgroups. African Americans had a higher but declining mortality risk than whites (RR, 1.12 in 1995 and 1.08 in 2001). Overall, disparities have narrowed since the national initiative. Trends of racial disparities for AMI varied more than those for pneumonia. Disparities in AMI were related to increased complications for Asians and low probability of receiving specialized procedures for AA and Hispanics. For pneumonia, the higher ED utilization for African Americans might result from lack of outpatient care. Different strategies must be employed for AMI and pneumonia, particularly with respect to African Americans and Asians. For pneumonia, the primary strategy should focus on ensuring access to outpatient care. For AMI, the focus should be on ensuring evidence-based medical care

Learning Objectives:

• Understand the trend of racial disparities before and after the 1997 national initiative to eliminate racial disparities by the year of 2010.
• Evaluate the impact of the national initiative to see whether we are no the right track to eliminate the racial disparities.
• Understand how policy makers, health care oversight agencies, and accrediting bodies can stimulate efforts by health care organizations to eliminate racial disparities.

Keywords: Health Disparities, Etiology

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Research grant from Agency for Healthcare Research and Quality