Epidemiology and ethics of coronary artery bypass surgery in an eastern county

Despite an extensive literature on coronary artery bypass grafting (CABG) surgery in the last decade, relatively little has been written on the demographic or socioeconomic characteristics of patients who receive this limited medical resource. In the present study data were collected on all patients (N = 539) who received this procedure over a one-year period (July 1977 to June 1978) within Erie County in western New York. Using available census tract data, age-sex adjusted surgery rates by socioeconomic status are developed for defined geographic areas. Patients residing in the city of Buffalo and those from census tracts in the lowest quartile of median family income have dramatically lower surgery rates than do others in the county (P less than .001). Although these discrepancies in CABG surgery rates may be partially explained by differing incidence rates of the medical indications for CABG surgery, problems of access to the service may be operative. Three different principles of distributive justice (equality, liberty, and utility) are discussed in an attempt to see how they might be applicable to the pattern documented.