Racial differences in cardiac catheterization use and appropriateness.
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.
Ferguson
J A
JA
Center for Health Services Research, Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana 46202, USA. ferguson@hsrd.iupui.edu
Adams
T A
TA
Weinberger
M
M
D001741:Black or African American / Q000706:statistics & numerical data*; D006328:Cardiac Catheterization / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000175:diagnosis; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D011287:Prejudice; D012189:Retrospective Studies; D044465:White People / Q000706:statistics & numerical data*