ASSOCIATION BETWEEN RACE/EHTNICITY AND

INCOME ON THE LIKELIHOOD OF CORONARY

REVASCULARIZATION AMONG POSTMENOPAUSAL
WOMEN WITH ACUTE MYOCARDIAL INFARCTION:
WOMEN’S HEALTH INITIATIVE STUDY
Critical Appraisal

Jasmine Nabilah
STUDY APPRAISAL BY CEBM OXFORD CRITERIA

Realibility

Importance

Applicability
 PICO ANALYSIS
Population Comparison
• Postmenopausal women with AMI • White women
with race/ethnicity & income data • Annual income >$20.000/year
whom undergone revascularization
or not

Interventions Outcome
• Black and Hispanic women • AMI with any receipt of coronary
• Annual income <$20.000/year revascularization (PCI or CABG)
Are the results of the study valid?
 1. Did the study address a clearly focused
issue?

Yes, there have been several

studies found that race, gender
and income disparities especially
Black, Women, dan lower
income in receiving various
revascularization procedure
when presenting AMI.
 2. Were there clearly defined groups of patients?
Yes, they conducted the study
across US using data from
Women’s Health Initiative Study
Race/ethnicity were defined as
non-hispanic Black, Hispanic and
non-hispanic White.
Income was categorized into 2
groups: <$20.000 & >=$20.000
Population included in this
cohort study are
postmenopausal women, age 50-
79 years with ethnicity and
income data who then having
AMI with revascularization or
not.
Patients with missing/unknown
data, self-reported MI at
enrollment and not able to
classify MI type also those who
had thrombolysis were excluded
3. Were outcome objectively measured?

Yes, all AMI outcomes were

identified by medical
record review by trained
physician using standard
three factors.

Revascularization outcome
whether PCI and CABG
were also adjudicated
based on hospitalization
timing of AMI.
4. Was the follow up subjects sufficiently long
enough and complete?

Yes, data were collected for

almost 2 decades from 1993
up until March 2019.
Subjects were followed until
the development of AMI.
 5. What are the results of the study?
Black women were less
likely to receive
revascularization than
White women. Between
Hispanic and White women
had similar likelihood.

Women with income

<$20.000 were less likely to
receive revascularization
than women with higher
income.
 ….What are the results of the study?

The Black and White

disparities did not improved
between pre and post 2010
time periods.

Annual income of less than

$20.000 was associated with
lower revascularization
irrespectively of the time
period
 6. Can the study results be extrapolated to
Indonesia?

No, because there were different race resided in

Indonesia.

Yes, there were also annual income disparities

between urban and rural cities/areas in Indonesia
which can also be reviewed.
 Conclusion

In this study, social determinants of healthcare are pertinent given the

relationship to accessing healthcare and attaining good health outcomes.

Black women and women whose income were <$20.000 annually is

significantly less likely to receive revascularization procedures for AMI.

Changes in policies and management of social determinants of health is

in need to eliminate disparities in treatment.
THANK YOU