{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T02:52:00Z","timestamp":1790650320881,"version":"4.1.0"},"reference-count":55,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,10,4]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Timely hospitalization of patients who are diagnosed with an acute coronary syndrome (ACS) at the emergency department (ED) is a crucial step to lower the risk of ACS mortality. We examined whether there are racial and ethnic differences in the risk of being discharged home among patients who received a diagnostic code of ACS at the ED and whether having health insurance plays a role.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We examined 51\u2009022\u2009910 discharge records of ED visits in Florida, New York, and Utah in the years 2008, 2011, 2014, and 2016\/2017 using state\u2010specific data from the Healthcare Cost and Utilization Project. We identified ED admissions for acute myocardial infarction or unstable angina using the\n              <jats:italic>International Classification of Diseases, Ninth Revision<\/jats:italic>\n              (\n              <jats:italic>ICD\u20109<\/jats:italic>\n              )\/\n              <jats:italic>International Statistical Classification of Diseases, Tenth Revision<\/jats:italic>\n              (\n              <jats:italic>ICD\u201010<\/jats:italic>\n              ) diagnostic codes. We used generalized estimating equation models to compare the risk of being discharged home across racial and ethnic groups. We used Poisson marginal structural models to estimate the mediating role of health insurance status. The proportion discharged home with a diagnostic code of ACS was 12% among Black patients, 6% among White patients, 9% among Hispanic patients, and 9% among Asian\/Pacific Islander patients. The incidence risk ratio for being discharged home was 1.26 (95% CI, 1.18\u20131.34) in Black patients, 1.23 (95% CI, 1.15\u20131.32) in Hispanic patients, and 1.11 (95% CI, 0.93\u20131.31) in Asian\/Pacific Islander patients compared with White patients. Race and ethnicity were marginally associated with discharge home via pathways not mediated by health insurance.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Racial and ethnic disparities exist in the hospitalization of patients who received a diagnostic code of ACS in the ED. Possible causes need to be investigated.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.122.025733","type":"journal-article","created":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T10:41:25Z","timestamp":1663756885000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Racial Disparities in Hospitalization Among Patients Who Receive a Diagnosis of Acute Coronary Syndrome in the Emergency Department"],"prefix":"10.1161","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6041-2320","authenticated-orcid":false,"given":"Duygu","family":"Islek","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University Atlanta GA"},{"name":"Department of Epidemiology, Laney Graduate School Emory University Atlanta GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed K.","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University Atlanta GA"},{"name":"Hubert Department of Global Health, Rollins School of Public Health Emory University Atlanta GA"},{"name":"Department of Family and Preventive Medicine, School of Medicine Emory University Atlanta GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2289-563X","authenticated-orcid":false,"given":"Amita","family":"Manatunga","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Rollins School of Public Health Emory University Atlanta GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2225-8323","authenticated-orcid":false,"given":"Alvaro","family":"Alonso","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University Atlanta GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9054-0654","authenticated-orcid":false,"given":"Viola","family":"Vaccarino","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University Atlanta GA"},{"name":"Division of Cardiology, Department of Medicine, School of Medicine Emory University Atlanta GA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000950"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.284.7.835"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.101.22.2557"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.163.19.2345"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000134"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.020828"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.4240"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2019.4845"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2010.00823.x"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2019.11.018"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.320.7251.1702"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200004203421603"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(87)90217-7"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(05)81945-6"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j239"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.249"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1204431"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.7103"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2013.03.029"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.24.2.398"},{"key":"e_1_3_1_22_2","unstructured":"Healthcare Cost and Utilization Project (HCUP) . Available at: https:\/\/www.hcup\u2010us.ahrq.gov\/. Accessed December 15 2021."},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.114.001029"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2018.02.036"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.4"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.04.037"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwv329"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e31824570bd"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e31821db37e"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e31818f69ce"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2019.02.003"},{"key":"e_1_3_1_32_2","unstructured":"Health Insurance Portability and Accountability Act of 1996 . Available at: https:\/\/aspe.hhs.gov\/reports\/health\u2010insurance\u2010portability\u2010accountability\u2010act\u20101996. Accessed September 4 2022."},{"key":"e_1_3_1_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(84)90625-8"},{"key":"e_1_3_1_34_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.1999.10198.x"},{"key":"e_1_3_1_35_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0092286"},{"key":"e_1_3_1_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2004.02.013"},{"key":"e_1_3_1_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2014.03.033"},{"key":"e_1_3_1_38_2","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12486"},{"key":"e_1_3_1_39_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-004-0008-x"},{"key":"e_1_3_1_40_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000157728.49918.9F"},{"key":"e_1_3_1_41_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.28.2.w368"},{"key":"e_1_3_1_42_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2015.302903"},{"key":"e_1_3_1_43_2","doi-asserted-by":"publisher","DOI":"10.1111\/acem.13214"},{"key":"e_1_3_1_44_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199902253400806"},{"key":"e_1_3_1_45_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.013592"},{"key":"e_1_3_1_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(02)01221-4"},{"key":"e_1_3_1_47_2","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.00148"},{"key":"e_1_3_1_48_2","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000000876"},{"key":"e_1_3_1_49_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2017.8628"},{"key":"e_1_3_1_50_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.0003"},{"key":"e_1_3_1_51_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.121.007868"},{"key":"e_1_3_1_52_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000001216"},{"key":"e_1_3_1_53_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.030564"},{"key":"e_1_3_1_54_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(00)01519-8"},{"key":"e_1_3_1_55_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.287.10.1269"},{"key":"e_1_3_1_56_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.922286"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.122.025733","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T10:57:32Z","timestamp":1715597852000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.122.025733"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,4]]},"references-count":55,"journal-issue":{"issue":"19","published-print":{"date-parts":[[2022,10,4]]}},"alternative-id":["10.1161\/JAHA.122.025733"],"URL":"https:\/\/doi.org\/10.1161\/jaha.122.025733","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,4]]},"assertion":[{"value":"2022-02-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-08-19","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-09-21","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e025733"}}