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Access to hospitals with high-technology cardiac services: how is race important?
1Division of General Medicine, Columbia College of Physicians and Surgeons, New York, NY 10032.
Insights
While initial presentation rates are similar, racial disparities exist in accessing high-technology cardiac services due to geographic proximity and travel patterns. Further research into these factors is warranted.
Area of Science:
- Cardiology
- Health Services Research
- Health Disparities
Background:
- Limited availability of high-technology cardiac services in US hospitals.
- Importance of timely access to cardiac catheterization, bypass surgery, and angioplasty for acute myocardial infarction (AMI).
Purpose of the Study:
- To investigate the association between patient race and admission to hospitals offering high-technology cardiac services.
- To understand racial differences in accessing advanced cardiac care during AMI.
Main Methods:
- Analysis of 11,410 patient records admitted with AMI in New York State in 1986.
- Multivariate modeling to adjust for home-to-hospital distance and analyze presentation patterns.
Main Results:
- Approximately one-third of both White and Black patients presented to hospitals with high-technology cardiac services.
- Distance-adjusted analysis revealed a higher likelihood (OR=1.68) for White patients to present to such facilities.
- Racial differences in proximity to high-technology hospitals and travel behaviors were identified.
Conclusions:
- Equal presentation rates to high-technology cardiac service hospitals for White and Black patients at the time of AMI.
- Significant underlying racial disparities in geographic access and travel patterns to advanced cardiac care facilities.
Objectives:
Relatively few hospitals in the United States offer high-technology cardiac services (cardiac catheterization, bypass surgery, or angioplasty). This study examined the association between race and admission to a hospital offering those services.
Methods:
Records of 11,410 patients admitted with acute myocardial infarction to hospitals in New York State in 1986 were analyzed.
Results:
Approximately one third of both White and Black patients presented to hospitals offering high-technology cardiac services. However, in a multivariate model adjusting for home-to-hospital distance, the White-to-Black odds ratio for likelihood of presentation to such a hospital was 1.68 (95% confidence interval = 1.42, 1.98). This discrepancy between the observed and "distance-adjusted" probabilities reflected three phenomena: (1) patients presented to nearby hospitals; (2) Blacks were more likely to live near high-technology hospitals; and (3) there were racial differences in travel patterns. For example, when the nearest hospitals did not include a high-technology hospital, Whites were more likely than Blacks to travel beyond those nearest hospitals to a high-technology hospital.
Conclusions:
Whites and Blacks present equally to hospitals offering high-technology cardiac services at the time of acute myocardial infarction. However, there are important underlying racial differences in geographic proximity and tendencies to travel to those hospitals.