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Racial differences in cardiac catheterization use and appropriateness
J A Ferguson1, T A Adams, M Weinberger
1Center for Health Services Research, Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana 46202, USA. ferguson@hsrd.iupui.edu
The American Journal of the Medical Sciences
|May 20, 1998
Summary
Racial disparities in cardiac catheterization rates are partly explained by medical appropriateness. White patients showed some overuse, while Black patients did not show underuse of cardiac catheterization.
Area of Science:
- Cardiology
- Health Disparities Research
- Health Services Research
Background:
- Previous studies identified interracial differences in cardiac procedure rates.
- The role of medical appropriateness in these disparities remained unclear.
Purpose of the Study:
- To investigate if medical appropriateness explains racial differences in cardiac catheterization (CC) rates.
- To determine if CC underuse or overuse contributes to these disparities.
Main Methods:
- Retrospective cohort study at a Veterans Affairs medical center.
- Used RAND appropriateness criteria for 200 male patients evaluated for cardiovascular disease in 1993.
- Compared CC rates between Black and White patients.
Main Results:
- Black patients were less likely than White patients to undergo CC (OR=0.23, P < 0.01).
- RAND criteria indicated fewer appropriate and more inappropriate CC candidates among Black patients.
- No CC underuse was observed in Black patients; 10% overuse was found in White patients.
Conclusions:
- Medical appropriateness partially explains interracial CC rate differences.
- Observed disparities are attributed to CC overuse in White patients, not underuse in Black patients.