Examination of racial differences in management of cardiovascular disease.
OBJECTIVE
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.
Ferguson
J A
JA
Center for Health Services Research, Roudebush Veterans Affairs Medical Center, Department of Medicine, Indiana University School of Medicine, Indianapolis 46202, USA. ferguson@hsrd.rupui.edu
Tierney
W M
WM
Westmoreland
G R
GR
Mamlin
L A
LA
Segar
D S
DS
Eckert
G J
GJ
Zhou
X H
XH
Martin
D K
DK
Weinberger
M
M
D001741:Black or African American / Q000706:statistics & numerical data*; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D006328:Cardiac Catheterization / Q000706:statistics & numerical data*; D015331:Cohort Studies; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000208:ethnology* / Q000401:mortality / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D015983:Selection Bias; D015996:Survival Rate; D044465:White People / Q000706:statistics & numerical data