Coronary revascularization and cardiac catheterization in the United States: trends in racial differences
R F Gillum1, B S Gillum, C K Francis
1Centers for Disease Control and Prevention, Hyattsville, Maryland 20782, USA.
Insights
Racial disparities in cardiac procedures like coronary artery bypass graft surgery (CABG) and percutaneous transluminal coronary angioplasty (PTCA) persist despite increased utilization. While cardiac catheterization rates showed improvement, significant gaps remain for CABG and PTCA.
Area of Science:
- Cardiovascular medicine
- Health disparities research
- Public health policy
Background:
- Previous studies highlighted racial disparities in coronary artery bypass graft (CABG) surgery utilization since 1982.
- Limited research has addressed changes in the relative use of revascularization procedures over time.
Purpose of the Study:
- To investigate whether racial differences in the rates of CABG, percutaneous transluminal coronary angioplasty (PTCA), and cardiac catheterization changed after 1980.
- To analyze trends in the utilization of these cardiac procedures across different racial groups.
Main Methods:
- Utilized data from the National Hospital Discharge Survey spanning 1980-1993.
- Calculated age-adjusted rates per 100,000 population for individuals aged 35-84 by year and race.
- Examined estimated numbers of procedures performed in U.S. nonfederal hospitals.
Main Results:
- Coronary artery bypass graft (CABG) surgery rates increased for both black and white patients from 1980-1993.
- The black/white ratio for CABG showed minimal change between 1986-1993, with persistent disparities.
- While percutaneous transluminal coronary angioplasty (PTCA) rates rose significantly for both races, the black/white ratio remained stable, indicating ongoing disparities. In contrast, inpatient cardiac catheterization rates increased more rapidly in black patients, narrowing the racial gap.
Conclusions:
- Rates for CABG, cardiac catheterization, and PTCA increased significantly between 1980-1993.
- Despite an increase in the black/white ratio for inpatient cardiac catheterization, substantial racial disparities in CABG and PTCA utilization persist.
- Further evaluation and potential interventions are necessary to address the persistent racial disparities in cardiovascular procedure utilization.
Objectives:
We sought to determine whether racial differences in rates of coronary artery bypass graft surgery (CABG), percutaneous transluminal coronary angioplasty (PTCA) and cardiac catheterization decreased after 1980.
Background:
Many reports of racial differences in utilization of CABG have been published since 1982. However, changes in the relative utilization of revascularization over time have received little attention.
Methods:
Data from the National Hospital Discharge Survey were examined for the years 1980 through 1993. Estimated numbers of procedures performed in nonfederal U.S. hospitals were used to compute age-adjusted rates per 100,000 population by year and race for patients 35 to 84 years old.
Results:
In patients 35 to 84 years old, the rate of CABG increased in blacks and whites between 1980 and 1993. Between 1986 and 1993, there was little change in the black/white ratio of age-adjusted rates (0.23 in 1980 through 1985 combined, 0.38 in 1986 and 0.43 in 1993). An apparent increase from 0.23 in 1980 through 1985 combined may have been due to sampling variation. Despite rapid increases in rates of PTCA in both races, no increase in the black/white ratio was noted (0.57 in 1993). However, the rate of inpatient cardiac catheterization increased more rapidly in blacks than in whites. This resulted in an increase in the black/white ratio of age-adjusted rates from 0.42 in 1980 to 0.91 in 1993.
Conclusions:
Rates of CABG, cardiac catheterization and especially PTCA increased between 1980 and 1993, a period during which racial disparities in the procedures became widely known. Despite apparent increases in the black/white ratio for inpatient cardiac catheterization, large racial disparities in the utilization of CABG and PTCA persist and require further evaluation and possible intervention.
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