Gender and ethnic disparities in outcome following acute myocardial infarction among Bedouins and Jews in Southern Israel

Background: Previous studies have documented gender-ethnic disparities in outcomes following acute myocardial infarction (AMI). This study evaluates such disparities in the Negev, Israel, and reviews potentially responsible mechanisms. Methods: Patients discharged with AMI were classified into young (< 70 years), elders (>= 70 years) and gender-ethnicity groups: Female Bedouins (FB), Female Jews (FJ), Male Bedouins (MB) and Male Jews (MJ). The primary outcome was 1-year all-cause mortality. Prognosis was assessed using Kaplan-Meier approach. Multivariable analyses assessing hazard ratios (HRs) for mortality were performed using the Cox proportional hazards regression models in two steps controlling for (i) the Ontario Acute Myocardial Infarction Mortality Prediction Rules (OAMIMPRs) and (ii) the OAMIMPR and additional potential confounders. Results: Of 2669 subjects, 45.8% were elders, 66.2% male and 10.9% Bedouin. The mortality rate was 12.3% (young 4.6%, elders 22%). Survival was significantly lower in FB compared with MB in the elderly stratum (P = 0.025). Multivariate analyses demonstrated similar risks for dying among the young. In the elders, the first multivariate analysis showed greater risk for mortality in FB. Using FB as the reference group, the HRs were as follows: HR(MB) = 0.36 [95% confidence interval (CI): 0.14-0.9]; HR(FJ) = 0.5 (95% CI: 0.27-0.9) and HR(MJ) = 0.5 (95% CI: 0.28-0.91). In the second analysis, the HRs were as follows: HR(MB) = 0.37 (95% CI: 0.14-0.93); HR(FJ) = 0.58 (95% CI: 0.32-1.07) and HR(MJ) = 0.56 (95% CI: 0.31-1.03). Conclusions: Elderly FB have poor 1-year prognosis following AMI compared with MB, MJ and FJ when controlling for the OAMIMPR model, yet when controlling for other potential confounders the differences are of borderline significance in relation to Jewish subjects. A culturally and economically sensitive programme focusing on tertiary prevention in these patients is warranted.