Ethnic differences in satisfaction and quality of life in veterans with ischemic heart disease

Abstract

OBJECTIVE: To assess differences in self-reported health status and satisfaction between African-American and caucasian veterans with ischemic heart disease (IHD). DATA SOURCES/STUDY SETTING: African-American and caucasian patients enrolled in General Internal Medicine clinics at six Veteran Affairs Medical Centers. STUDY DESIGN: We conducted a cross-sectional analysis of baseline survey data from the Ambulatory Care Quality Improvement Project (ACQUIP). Patients who responded to an initial health-screening questionnaire were sent follow-up surveys, which included the Medical Outcomes Study 36-item Health Survey (SF-36), the Seattle Outpatient Satisfaction Questionnaire (SOSQ), and the Seattle Angina Questionnaire (SAQ). PRINCIPAL FINDINGS: Of the 44,965 patients approached, 27,977 (62%) returned the baseline survey, of which 10,385 patients reported IHD and were sent the SAQ. Of those, 7,985 patients (84% caucasian, 16% African-American) responded. Caucasian respondents tended to be older, married, nonsmokers, with annual incomes over dollar 10,000, and had higher educational attainment than African Americans. African-American patients reported significantly fewer cardiac procedures (33% vs. 52%, p < 0.001) but were more likely to have diabetes (37% vs. 28%, p < 0.001) and hypertension (81% vs. 68%, p < 0.001). After adjustment for demographic characteristics, comorbid conditions, clinic site, and site-ethnicity interactions, SF-36 scores for physical function, role physical, bodily pain, and vitality were greater for African Americans than caucasians, while adjusted scores were significantly lower for role emotional. However, because of the site-ethnicity interaction, scores varied significantly by site. For the SAQ, overall adjusted physical function summary scores and disease stability scores were significantly greater for African Americans than caucasians. Adjusted summary satisfaction scores for provider satisfaction were not significantly lower for African Americans overall but were significant at two of six sites. Similarly, on the SAQ, adjusted treatment satisfaction scores were significantly lower for African Americans at half of the sites and minimally but not clinically significant overall. CONCLUSIONS: Despite a higher prevalence of cardiac risk factors, African-American patients with CAD who were treated in the VA system appeared to have a greater level of physical functioning, vitality, and angina stability. After adjustment for confounding demographic variables, however, these differences were not consistently significant at all geographic locations. This suggests that many other sociodemographic variables, in addition to ethnicity, influence apparent discrepancies in quality of life, satisfaction, and angina.