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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
Insights
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.
Abstract:
The authors sought to investigate the role of medical appropriateness as a potential explanatory factor in previously observed interracial cardiac procedure rate differences. A retrospective cohort study using RAND appropriateness criteria was conducted at a Veterans Affairs medical center among a sample of patients who were evaluated for cardiovascular disease during 1993 (n=200). All participants were men and 50% were black (mean age=61.8 years). Blacks were less likely than whites to undergo cardiac catheterizations (CC) (odds ratio [OR]=0.23, P < 0.01). When RAND criteria were applied, blacks were found to have fewer indications that made them appropriate candidates for CC and more indications making them inappropriate candidates for CC (chi-square test, P < 0.05). No CC procedure underuse was found among blacks, whereas 10% of CC overuse was found among whites. Interracial CC procedure use differences were not due to procedure underuse among blacks but were in part due to overuse among whites.