title: Do race and gender influence the use of invasive procedures?
abstract: OBJECTIVE
  To assess the influence of race and gender influence on the use of invasive procedures in patients with acute myocardial infarction (AMI) in community hospitals.
  
  
  METHODS
  Prospective, observational.
  
  
  METHODS
  Five mid-Michigan community hospitals.
  
  
  METHODS
  All patients (838) identified with AMI between January 1994 and April 1995 in 1 of these hospitals.
  
  
  RESULTS
  After adjusting for age, hospital of admission, insurance type, severity of AMI, and comorbidity, using white men as the reference group, the rate of being offered cardiac catheterization (CC) was 0.88 (95% confidence interval [95% CI], 0.60 to 1.29) for white women; 0.79 (95% CI, 0.41 to 1.50) for black men; and 1.14 (95% CI, 0.53 to 2.45)for black women. Among patients who underwent CC, after also adjusting for coronary artery anatomy, the rate of being offered angioplasty, using white men as the reference group, was 1.22 (95% CI, 0.75 to 1.98) for white women; 0.61 (5% CI, 0.29 to 1.28, P =.192) for black men; and 0.40 (95% CI, 0.14 to 1.13) for black women The adjusted rate of being offered bypass surgery was 0.47 (95% CI, 0.24 to 0.89) for white women; 0.36 (95% CI, 0.12 to 1.06) for black men; and 0.37 (95% CI, 0.11 to 1.28)for black women.
  
  
  CONCLUSIONS
  Our study shows that white women are less likely than white men to be offered bypass surgery after AMI. Although black men and women with AMI are less likely than white men to be offered percutaneous transluminal coronary angioplasty or coronary artery bypass grafting in both unadjusted and adjusted analyses, these findings did not reach statistical significance. Our study is limited in power due to the small number of blacks in the sample.
authors.affiliation: College of Human Medicine, Michigan State University, East Lansing, MI 48824-1315, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Watson
authors.forename: A D
authors.initials: AD
authors.lastname: Stein
authors.forename: F C
authors.initials: FC
authors.lastname: Dwamena
authors.forename: J
authors.initials: J
authors.lastname: Kroll
authors.forename: R
authors.initials: R
authors.lastname: Mitra
authors.forename: B A
authors.initials: BA
authors.lastname: McIntosh
authors.forename: P
authors.initials: P
authors.lastname: Vasilenko
authors.forename: M M
authors.initials: MM
authors.lastname: Holmes-Rovner
authors.forename: Q
authors.initials: Q
authors.lastname: Chen
authors.forename: J
authors.initials: J
authors.lastname: Kupersmith
mesh_terms: D001741:Black or African American; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D044383:Black People; D006328:Cardiac Catheterization / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology* / Q000628:therapy*; D010822:Physicians, Women; D011446:Prospective Studies; D012737:Sex Factors; D044465:White People