Yu Han, PhD; Liu Hong, PhD; Jianhua Qiu, PhD
Potential Conflicts of Interest: None disclosed.
Han Y., Hong L., Qiu J.; Racial Differences in Myocardial Infarction Outcomes. Ann Intern Med. 2009;151:823. doi: 10.7326/0003-4819-151-11-200912010-00018
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Published: Ann Intern Med. 2009;151(11):823.
TO THE EDITOR:
Spertus and colleagues (1) concluded that black patients with myocardial infarction have worse outcomes than white patients. Although the study was potentially clinically directive, we have 2 concerns. First, because the white patients were mostly men, the findings must be extrapolated to women with caution. Furthermore, enrollment bias may have caused the difference in proportions of men between the 2 groups. Second, the fundamental question of causality between racial differences and myocardial infarction outcomes could not be answered in this observational study. Thus, before speculating about the putative mechanisms underlying the observed survival advantage of white over black persons, perhaps one should investigate the cause of the nonsignificant differences between the groups after adjustment for patient factors and site of care.
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