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Examination of racial differences in management of cardiovascular disease
J A Ferguson1, W M Tierney, G R Westmoreland
1Center for Health Services Research, Roudebush Veterans Affairs Medical Center, Department of Medicine, Indiana University School of Medicine, Indianapolis 46202, USA. ferguson@hsrd.rupui.edu
Insights
Racial disparities in invasive cardiac procedures exist, influenced by clinical factors and selection bias. However, survival rates for African Americans and whites were similar after these procedures.
Area of Science:
- Cardiovascular Medicine
- Health Disparities Research
- Medical Procedure Outcomes
Background:
- Previous reports indicate interracial differences in invasive cardiac procedure utilization.
- The specific reasons behind these disparities remain unclear.
Purpose of the Study:
- To identify clinical characteristics associated with interracial differences in invasive cardiac procedures.
- To examine how cohort selection criteria impact these disparities.
- To determine survival rates among different racial groups undergoing these procedures.
Main Methods:
- Retrospective cohort study at a Veterans Affairs Medical Center.
- Evaluated 1,406 male patients for cardiovascular disease in 1993.
- Analyzed utilization of cardiac catheterization, coronary angioplasty, and coronary bypass surgery.
Main Results:
- African Americans were less likely than whites to undergo invasive cardiac procedures (e.g., cardiac catheterization OR 0.37).
- Bivariate analysis showed patients undergoing procedures were younger, married, and healthier.
- Adjusting for referral status and diagnoses reduced or eliminated observed interracial differences.
- Thirty-day and 1-year survival rates were equivalent (96% and 87.6%).
Conclusions:
- Clinical differences and cohort selection bias may partially explain racial disparities in invasive cardiac procedure use.
- Despite differences in treatment, survival outcomes were comparable between African Americans and whites.
Objectives:
We sought to identify the clinical characteristics associated with, and to investigate the impact of cohort selection criteria on, interracial use of invasive cardiac procedures and to determine survival.
Background:
Although interracial differences in the use of invasive cardiac procedures have been previously reported, the underlying reasons are not known.
Methods:
A retrospective cohort study was conducted at a Veterans Affairs Medical Center. Study patients were evaluated for cardiovascular disease between January 1 and December 31, 1993.
Results:
The study included 1,406 male patients (85% white, 58% married), with a mean age of 63.4 years. African Americans were less likely than whites to undergo procedures (cardiac catheterization: odds ratio [OR] 0.37, 95% confidence interval [CI] 0.24 to 0.58; coronary angioplasty: OR 0.60, 95% CI 0.25 to 1.49; coronary bypass surgery: OR 0.22, 95% CI 0.08 to 0.63; any procedure: OR 0.32, 95% CI 0.21 to 0.50). On bivariate analysis, patients who underwent cardiac procedures were more likely to be younger, married and reside nonlocally and less likely to have severe comorbid disease; however, African Americans were less likely to be married and to reside nonlocally and more likely to have severe comorbid disease. Cohorts adjusting for referral status and specified cardiac diagnoses reduced or reversed interracial treatment differences. Thirty-day and 1-year survival rates (96% and 87.6%, respectively) were equivalent.
Conclusions:
Racial disparity in invasive cardiac procedure use may be partially explained by clinical differences and cohort selection bias. Despite treatment differences, survival rates were equivalent in African Americans and whites.