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Racial differences in admissions to high-quality hospitals for coronary heart disease
Ioana Popescu1, Brahmajee K Nallamothu, Mary S Vaughan-Sarrazin
1Department of Internal Medicine, The University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52240, USA. Ioana-popescu@uiowa.edu
Insights
Black patients with acute myocardial infarction or coronary artery bypass grafting were equally or more likely to access top hospitals. However, socially disadvantaged Black patients undergoing CABG were less likely to be admitted to high-quality cardiac care facilities.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Racial Disparities in Healthcare
Background:
- Racial disparities in healthcare access and quality are a significant concern.
- Black patients with coronary heart disease (CHD) are often treated at lower-quality hospitals.
- Limited data exists on racial differences in accessing high-quality cardiac care facilities.
Purpose of the Study:
- To investigate racial differences in Medicare patients' admission to top-ranked cardiac hospitals.
- To analyze admission patterns for acute myocardial infarction (AMI) and coronary artery bypass grafting (CABG) based on race.
- To identify factors influencing access to high-quality cardiac care for Black and White patients.
Main Methods:
- Identified Black and White Medicare patients undergoing AMI or CABG between 2002-2005.
- Utilized US News and World Report's "America's Best Hospitals" rankings to identify top-ranked cardiac hospitals.
- Employed multinomial conditional logit models, accounting for patient distance to hospitals, to assess admission likelihood.
Main Results:
- Unadjusted analyses showed Black patients were more likely to be admitted to top-ranked hospitals for AMI and CABG.
- After adjusting for distance, Black patients with AMI were more likely to be admitted to top-ranked hospitals (OR 1.12).
- Black patients undergoing CABG were equally likely to be admitted to top-ranked hospitals (OR 1.05), but less likely in socially disadvantaged areas (OR 0.75).
Conclusions:
- Black Medicare patients with AMI or undergoing CABG generally had equal or greater likelihood of admission to top-ranked hospitals.
- A significant exception was observed for socially disadvantaged Black patients undergoing CABG, who were less likely to access these facilities.
- Findings highlight the complex interplay of race, socioeconomic status, and access to high-quality cardiovascular care.
Background:
Research increasingly shows that blacks with coronary heart disease (CHD) are treated at lower-quality hospitals. Little is known about racial differences in admission to high-quality hospitals.
Methods:
We identified all black and white Medicare patients with acute myocardial infarction and coronary artery bypass grafting (CABG) admitted during 2002 through 2005 to hospitals located in markets with top-ranked cardiac hospitals, as ascertained from the US News and World Report "America's Best Hospitals" annual rankings. The relationship between race and admission to top-ranked hospitals was estimated using multinomial conditional logit models to account for distance from patient residence to all available hospitals.
Results:
In unadjusted analyses, blacks with AMI or undergoing CABG, compared with whites, were more likely to be admitted to top-ranked hospitals (18.3% vs 10.5% and 34.4% vs 22.7% [P < .001]) but also more likely to bypass top-ranked hospitals (25.8% vs 14.7% and 37.5% vs 26.3% [P < .001]). In models accounting for distance, blacks with acute myocardial infarction were more likely (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.08-1.16 [P < .001]), whereas blacks undergoing CABG were equally likely (OR, 1.05; 95% CI, 0.97-1.13; P = .27) to be admitted to top-ranked hospitals compared with whites. However, within socially disadvantaged zip codes, blacks undergoing CABG were less likely to receive care at top-ranked hospitals (OR, 0.75; 95% CI, 0.64-0.86 [P < .001]) compared with whites and more likely to bypass top-ranked hospitals located closer to their residence (OR, 1.16; 95% CI, 1.02-1.30 [P = .03]).
Conclusion:
Black Medicare patients with acute myocardial infarction or undergoing CABG were equally or more likely to be admitted to top-ranked hospitals, except for socially disadvantaged black patients undergoing CABG.
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