Racial and ethnic differences in time to acute reperfusion therapy for patients hospitalized with myocardial infarction

Elizabeth H. Bradley, Jeph Herrin, Yongfei Wang, Robert L. McNamara, Tashonna R. Webster, David J. Magid, Martha Blaney, Eric D. Peterson, John G. Canto, Charles V. Pollack, Harlan M. Krumholz

Research output: Contribution to journalArticlepeer-review

217 Scopus citations


Context: Nonwhite patients experience significantly longer times to fibrinolytic therapy (door-to-drug times) and percutaneous coronary intervention (door-to-balloon times) than white patients, raising concerns of health care disparities, but the reasons for these patterns are poorly understood. Objectives: To estimate race/ethnicity differences in door-to-drug and door-to-balloon times for patients receiving primary reperfusion for ST-segment elevation myocardial infarction; to examine how sociodemographic factors, insurance status, clinical characteristics, and hospital features mediate racial/ethnic differences. Design, Setting, and Patients: Retrospective, observational study using admission and treatment data from the National Registry of Myocardial Infarction (NRMI) for a US cohort of patients with ST-segment elevation myocardial infarction or left bundle-branch block and receiving reperfusion therapy. Patients (73032 receiving fibrinolytic therapy; 37143 receiving primary percutaneous coronary intervention) were admitted from January 1, 1999, through December 31, 2002, to hospitals participating in NRMI 3 and 4. Main Outcome Measure: Minutes between hospital arrival and acute reperfusion therapy. Results: Door-to-drug times were significantly longer for patients identified as African American/black (41.1 minutes), Hispanic (36.1 minutes), and Asian/Pacific Islander (37.4 minutes), compared with patients identified as white (33.8 minutes) (P<.01 for all). Door-to-balloon times for patients identified as African American/black (122.3 minutes) or Hispanic (114.8 minutes) were significantly longer than for patients identified as white (103.4 minutes) (P<.001 for both). Racial/ethnic differences were still significant but were substantially reduced after accounting for differences in mean times to treatment for the hospitals in which patients were treated; significant racial/ethnic differences persisted after further adjustment for sociodemographic characteristics, insurance status, and clinical and hospital characteristics (P<.01 for all). Conclusion: A substantial portion of the racial/ethnic disparity in time to treatment was accounted for by the specific hospital to which patients were admitted, in contrast to differential treatment by race/ethnicity inside the hospital.

Original languageEnglish (US)
Pages (from-to)1563-1572
Number of pages10
JournalJournal of the American Medical Association
Issue number13
StatePublished - Oct 6 2004
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)


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