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Racial differences in the use of invasive cardiovascular procedures in the Department of Veterans Affairs medical
J Whittle1, J Conigliaro, C B Good
1Section of General Internal Medicine, Pittsburgh Veterans Affairs Medical Center, PA 15240.
Insights
Even without financial incentives, white veterans received more invasive cardiac procedures than black veterans. This suggests social or clinical factors influence disparities in cardiovascular care for different races.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Health Disparities
Background:
- Previous studies indicate racial disparities in invasive cardiovascular procedure utilization, potentially linked to financial incentives favoring white patients.
- Department of Veterans Affairs (VA) hospitals minimize direct financial incentives for physicians and patients regarding these procedures.
Purpose of the Study:
- To investigate racial differences in the use of invasive cardiovascular procedures among black and white male veterans within the VA system.
- To determine if racial disparities persist in the absence of significant financial incentives.
Main Methods:
- Retrospective analysis of VA hospital discharge data from fiscal years 1987-1991.
- Inclusion criteria: male veterans with primary cardiovascular disease or chest pain diagnoses.
- Logistic-regression analysis adjusted for clinical factors, demographics, and hospital characteristics to compare rates of cardiac catheterization, angioplasty, and coronary artery bypass grafting.
Main Results:
- Adjusted analysis revealed white veterans were significantly more likely than black veterans to undergo cardiac catheterization (OR, 1.38).
- White veterans had higher odds of receiving percutaneous transluminal coronary angioplasty (OR, 1.50) and coronary artery bypass grafting (OR, 2.22).
Conclusions:
- Racial disparities in invasive cardiac procedure use exist even when financial incentives are minimized.
- Findings suggest that social or clinical factors, beyond financial considerations, contribute to racial differences in cardiovascular care access and utilization.
Background:
Previous studies have found racial differences in the use of invasive cardiovascular procedures, which may be due in part to the greater financial incentives to perform such procedures in white patients. In Department of Veterans Affairs hospitals, direct financial incentives affecting use of the procedures are minimized for both patients and physicians.
Methods:
We conducted a retrospective analysis of the use of cardiovascular procedures among black and white male veterans discharged from Veterans Affairs hospitals with primary diagnoses of cardiovascular disease or chest pain during fiscal years 1987 through 1991. We used coded discharge data to determine whether cardiac catheterization, percutaneous transluminal coronary angioplasty, or coronary artery bypass grafting was performed during or immediately after such admissions. We used logistic-regression analysis to adjust for the primary discharge diagnosis, the presence of coexisting conditions, age, marital status, type of eligibility to receive care at Veterans Affairs hospitals, geographic region, and whether the hospital was equipped to perform bypass surgery. We classified the primary diagnosis as myocardial infarction, unstable angina, angina, chronic ischemia, chest pain, or "other" cardiovascular diagnosis.
Results:
After we adjusted for all the potential confounders, we found that white veterans were more likely than black veterans to undergo cardiac catheterization (odds ratio, 1.38; 95 percent confidence interval, 1.34 to 1.42), angioplasty (odds ratio, 1.50; 95 percent confidence interval, 1.38 to 1.64), and coronary artery bypass surgery (odds ratio, 2.22; 95 percent confidence interval, 2.09 to 2.36).
Conclusions:
Even when financial incentives are absent, whites are more likely than blacks to undergo invasive cardiac procedures. These findings suggest that social or clinical factors affect the use of these procedures in blacks and whites.