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Racial disparities in revascularization rates among patients with similar insurance coverage

Peter Cram1, Levent Bayman, Ioana Popescu

  • 1Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA. peter-cram@uiowa.edu

Journal of the National Medical Association
|December 17, 2009
PubMed

Insights

Racial disparities persist in coronary revascularization for acute myocardial infarction (AMI) patients. Even with similar insurance, Black and Hispanic individuals receive fewer procedures than White patients.

Area of Science:

  • Cardiovascular Medicine
  • Health Services Research
  • Health Disparities

Background:

  • Extensive documentation exists on racial disparities in coronary revascularization procedures like percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).
  • The consistency of these disparities among patients with similar health insurance coverage remains unclear.
  • Acute myocardial infarction (AMI) is a critical condition where timely revascularization is crucial.

Purpose of the Study:

  • To assess racial disparities in coronary revascularization (PCI or CABG) among White, Black, and Hispanic patients.
  • To specifically examine these disparities in patients hospitalized with AMI and having similar health insurance coverage.
  • To determine if insurance status explains observed racial differences in revascularization rates.

Main Methods:

  • Utilized 2000-2005 state inpatient data from nine states.
  • Identified White, Black, and Hispanic patients hospitalized with AMI.
  • Grouped patients into three insurance cohorts: Medicare, private insurance, and Medicaid/uninsured, examining revascularization rates within each.

Main Results:

  • Across all insurance cohorts (Medicare, private, Medicaid/uninsured), Black and Hispanic patients were significantly less likely to receive in-hospital revascularization compared to White patients.
  • Unadjusted analyses showed lower rates for Black and Hispanic patients in all insurance groups.
  • Adjusted Cox models revealed Black patients were approximately 25% less likely and Hispanic patients 5% less likely to receive revascularization than White patients with similar insurance.

Conclusions:

  • Black patients hospitalized with AMI receive significantly less revascularization compared to White and Hispanic patients, even when they have similar health insurance.
  • The findings indicate that patients' ability to pay for procedures is unlikely to be the primary driver of these racial disparities.
  • Further research is needed to address the underlying causes of these persistent disparities in cardiovascular care.
Abstract

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