Racial disparities in the use of cardiac revascularization: does local hospital capacity matter?
Suhui Li1, Arnold Chen, Katherine Mead
1Department of Health Policy, George Washington University, Washington, District of Columbia, United States of America. suhuili@gwu.edu
Insights
Racial disparities in cardiac revascularization exist, influenced by county-level variations and hospital capacity. Limited resources disproportionately affect Black patients, widening the gap in procedures like coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI).
Area of Science:
- Cardiovascular medicine
- Health services research
- Health equity
Background:
- Racial disparities in cardiac revascularization procedures are well-documented.
- The influence of geographic location and local hospital resources on these disparities requires further investigation.
Purpose of the Study:
- To examine how county-level variations in healthcare access explain racial disparities in cardiac revascularization.
- To assess the association between local hospital capacity and within-county racial disparities in these procedures.
Main Methods:
- Analysis of administrative data for 207,570 Medicare patients with acute myocardial infarction (AMI) in Pennsylvania (1995-2006).
- Utilized multi-level hierarchical models to evaluate the impact of county-level factors and hospital capacity on racial differences in coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) use.
- Examined procedure rates within three months of AMI admission.
Main Results:
- Black patients were less likely to receive CABG (5.8% vs. 9.1%) and PCI (14.2% vs. 15.7%) compared to white patients.
- County-level adjustments altered the magnitude of state-level racial disparities for CABG and PCI.
- Increased availability of revascularization hospitals per capita was linked to smaller within-county racial disparities; however, limited capacity in catheterization suites and AMI hospitals exacerbated racial gaps in PCI.
Conclusions:
- Geographic variations in cardiac revascularization rates contribute to observed racial disparities.
- While reduced hospital capacity impacts both racial groups, it disproportionately affects Black patients, potentially leading to poorer outcomes.
- Addressing hospital resource allocation is crucial for mitigating racial inequities in cardiovascular care.
Objective:
To assess the extent to which the observed racial disparities in cardiac revascularization use can be explained by the variation across counties where patients live, and how the within-county racial disparities is associated with the local hospital capacity.
Data Sources:
Administrative data from Pennsylvania Health Care Cost Containment Council (PHC4) between 1995 and 2006.
Study Design:
The study sample included 207,570 Medicare patients admitted to hospital for acute myocardial infarction (AMI). We identified the use of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) procedures within three months after the patient's initial admission for AMI. Multi-level hierarchical models were used to determine the extent to which racial disparities in procedure use were attributable to the variation in local hospital capacity.
Principal Findings:
Blacks were less likely than whites to receive CABG (9.1% vs. 5.8%; p<0.001) and PCI (15.7% vs. 14.2%; p<0.001). The state-level racial disparity in use rate decreases for CABG, and increases for PCI, with the county adjustment. Higher number of revascularization hospitals per 1,000 AMI patients was associated with smaller within-county racial differences in CABG and PCI rates. Meanwhile, very low capacity of catheterization suites and AMI hospitals contributed to significantly wider racial gap in PCI rate.
Conclusions:
County variation in cardiac revascularization use rates helps explain the observed racial disparities. While smaller hospital capacity is associated with lower procedure rates for both racial groups, the impact is found to be larger on blacks. Therefore, consequences of fewer medical resources may be particularly pronounced for blacks, compared with whites.
