Racial differences in the use of cardiac catheterization after acute myocardial infarction
J Chen1, S S Rathore, M J Radford
1Department of Medicine, Yale University School of Medicine, New Haven, Conn, USA.
Insights
Racial disparities in cardiac catheterization after heart attack persist regardless of physician race. This suggests patient race, not physician race, influences treatment patterns for acute myocardial infarction.
Area of Science:
- Cardiology
- Health Disparities
- Health Services Research
Background:
- Studies indicate Black patients receive cardiac catheterization less often than White patients post-acute myocardial infarction.
- The influence of physician race on this observed disparity remains unexplored.
Purpose of the Study:
- To investigate whether the race of the attending physician impacts the difference in cardiac catheterization rates between Black and White patients following acute myocardial infarction.
Main Methods:
- Analysis of Medicare beneficiaries hospitalized for acute myocardial infarction in 1994-1995 from the Cooperative Cardiovascular Project.
- Evaluation of cardiac catheterization use within 60 days, stratified by patient and physician race.
Main Results:
- Black patients consistently had lower cardiac catheterization rates than White patients, irrespective of physician race (White physicians: 38.4% vs. 45.7%; Black physicians: 38.2% vs. 49.6%).
- No significant interaction was found between patient race and physician race regarding cardiac catheterization utilization.
- Adjusted mortality rates were similar or lower for Black patients compared to White patients up to three years post-infarction.
Conclusions:
- Observed racial differences in cardiac catheterization use after acute myocardial infarction are consistent across both White and Black physicians.
- These findings suggest that the pattern of care is independent of the physician's race.
Background:
Several studies have reported that black patients are less likely than white patients to undergo cardiac catheterization after acute myocardial infarction. The role of the race of the physician in this pattern is unknown.
Methods:
We analyzed data from the Cooperative Cardiovascular Project, a study of Medicare beneficiaries hospitalized for acute myocardial infarction in 1994 and 1995, to evaluate whether differences between black patients and white patients in the use of cardiac catheterization within 60 days after acute myocardial infarction varied according to the race of their attending physician.
Results:
Our study cohort consisted of 35,676 white and 4039 black patients with acute myocardial infarction who were treated by 17,550 white and 588 black physicians. Black patients had lower rates of cardiac catheterization than white patients, regardless of whether their attending physician was white (rate of catheterization, 38.4 percent vs. 45.7 percent; P< 0.001) or black (38.2 percent vs. 49.6 percent, P<0.001). We did not find a significant interaction between the race of the patients and the race of the physicians in the use of cardiac catheterization. The adjusted mortality rate among black patients was lower than or similar to that among white patients for up to three years after the infarction.
Conclusions:
Racial differences in the use of cardiac catheterization are similar among patients treated by white physicians and those treated by black physicians, suggesting that this pattern of care is independent of the race of the physician.
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