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Racial differences in the use of revascularization procedures after coronary angiography
J Z Ayanian1, I S Udvarhelyi, C A Gatsonis
1Division of General Medicine, Brigham and Women's Hospital, Boston, MA.
Insights
White patients are more likely than Black patients to receive coronary revascularization procedures after angiography. These disparities persist across most hospital types, suggesting potential underuse in Black patients or overuse in White patients.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Health Disparities
Background:
- Coronary revascularization procedures are critical interventions for managing coronary heart disease.
- Understanding racial disparities in access to and utilization of these procedures is essential for equitable healthcare.
- Previous research suggests potential racial differences in cardiovascular care, but specific data on revascularization post-angiography is needed.
Purpose of the Study:
- To investigate racial differences in the rates of coronary revascularization procedures (coronary angioplasty or bypass graft surgery) between Black and White patients following coronary angiography.
- To examine the relationship between these racial disparities and various hospital characteristics.
Main Methods:
- A retrospective cohort study utilizing national Medicare claims data from 1987-1988.
- Analysis included 27,485 Medicare beneficiaries (aged 65-74) who underwent inpatient coronary angiography.
- Adjusted odds ratios were calculated to compare revascularization rates between White and Black patients, controlling for demographic, clinical, and hospital factors.
Main Results:
- White patients were significantly more likely than Black patients to undergo revascularization procedures post-angiography (57% vs. 40% for men, 50% vs. 34% for women).
- The adjusted odds of receiving revascularization were 78% higher for White patients compared to Black patients.
- Significant racial differences were observed in all hospital types except rural hospitals and did not vary by hospital characteristics.
Conclusions:
- Significant racial disparities exist in the utilization of coronary revascularization procedures among Medicare enrollees after coronary angiography.
- These disparities are consistent across various hospital settings, suggesting systemic issues rather than access limitations.
- Potential contributing factors include unmeasured clinical or socioeconomic factors, patient preferences, or racial bias, highlighting the need for further investigation into the causes of these disparities.
Objective:
To assess whether rates of coronary revascularization procedures differ between blacks and whites after coronary angiography is performed and to assess the relationship of these rates to hospital characteristics.
Design:
A retrospective cohort study using 1987 and 1988 data on hospital claims and characteristics from the Health Care Financing Administration.
Setting:
One thousand four hundred twenty-nine acute care hospitals that provide coronary angiography in the United States.
Patients:
A national sample of 27,485 Medicare Part A enrollees, aged 65 to 74 years, who underwent inpatient angiography for coronary heart disease in 1987.
Main Outcome Measure:
The adjusted odds of revascularization with either coronary angioplasty or bypass graft surgery within 90 days of angiography for whites relative to blacks, controlling for age, sex, region, Medicaid eligibility, principal diagnosis, comorbid diagnoses, and hospital characteristics of ownership, teaching status, urban/suburban or rural location, and availability of revascularization procedures.
Results:
White men and women were significantly more likely than black men and women, respectively, to receive a revascularization procedure after coronary angiography (57% and 50% vs 40% and 34%, both P < .001). The adjusted odds of receiving a revascularization procedure after coronary angiography were 78% higher for whites than blacks (95% confidence interval for odds ratio, 1.56 to 2.03). Statistically significant racial differences in the adjusted odds of receiving a revascularization procedure were present in all types of hospitals except rural hospitals, and these differences did not vary significantly by any of the four hospital characteristics (all P > .20 for interaction terms).
Conclusions:
Among Medicare enrollees, whites are more likely than blacks to receive revascularization procedures after coronary angiography. Racial differences of similar magnitude occur in all types of hospitals. These differences may reflect overuse in whites or underuse in blacks, but they are unlikely to reflect access to cardiologists or hospitals that perform revascularization procedures. Potential explanations include unmeasured clinical or socioeconomic factors, differing patient preferences, and racial bias at the hospitals performing angiography.
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