Gender and ethnic differences in hospital-based procedure utilization in California

To examine several hospital-based procedures for systematic utilization differences between the genders and among ethnic groups (Asian, black, Latino, and white).

California hospital discharges in 1989 and 1990 were sampled by principal diagnosis. Odds ratios for treatment by demographic class were estimated for heart transplantation, kidney transplantation, extracorporeal shockwave lithotripsy, hip replacement, carotid endarterectomy, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, pacemaker implant, and automatic cardioverter-defibrillator implant. Logistic regression controlled for insurance status, age, diagnosis, and comorbidity count.

The following results were statistically significant (P < .05). Males' odds of receiving most procedures exceeded those of females by 115% (odds ratio, 2.15) for coronary artery bypass grafting, 86% for heart transplantation, 38% for defibrillator implants, 34% for angioplasty, 28% for pacemaker implants, and 24% for hip replacement. Whites' odds of receiving several procedures exceeded those of blacks by 204% for kidney transplantation, 186% for defibrillator implant, 144% for coronary artery bypass grafting, 127% for endarterectomy, and 100% for angioplasty. Whites' odds of receiving some procedures also exceeded those of Latinos by 72% for angioplasty, 58% for kidney transplantation, and 49% for coronary artery bypass grafting. Whites' odds of receiving endarterectomy or angioplasty exceeded those of Asians by 108% and 30%, respectively. Asians had 113% higher odds than whites of receiving hip replacement.

The array of utilization differences across 4 demographic comparisons and 9 hospital procedures suggests systematic trends in high-technology allocation. Generally, women received procedures less often than men and minorities less than whites.