Racial disparity in cardiac procedures and mortality among long-term survivors of cardiac arrest.
BACKGROUND
It is unknown whether white and black Medicare beneficiaries have different rates of cardiac procedure utilization or long-term survival after cardiac arrest.


RESULTS
A total of 5948 elderly Medicare beneficiaries (5429 white and 519 black) were identified who survived to hospital discharge between 1990 and 1999 after admission for cardiac arrest. Demographic, socioeconomic, and clinical information about these patients was obtained from Medicare administrative files, the US census, and the American Hospital Association's annual institutional survey. A Cox proportional hazard model that included demographic and clinical predictors indicated a hazard ratio for mortality of 1.30 (95% CI 1.09 to 1.55) for blacks aged 66 to 74 years compared with whites of the same age. The addition of cardiac procedures to this model lowered the hazard ratio for blacks to 1.23 (95% CI 1.03 to 1.46). In analyses stratified by race, implantable cardioverter-defibrillators (ICDs) had a mortality hazard ratio of 0.53 (95% CI 0.45 to 0.62) for white patients and 0.50 (95% CI 0.27 to 0.91) for black patients. Logistic regression models that compared procedure rates between races indicated odds ratios for blacks aged 66 to 74 years of 0.58 (95% CI 0.36 to 0.94) to receive an ICD and 0.50 (95% CI 0.34 to 0.75) to receive either revascularization or an ICD.


CONCLUSIONS
There is racial disparity in long-term mortality among elderly cardiac arrest survivors. Both black and white patients benefited from ICD implantation, but blacks were less likely to undergo this potentially life-saving procedure. Lower rates of cardiac procedures may explain in part the lower survival rates among black patients.
Groeneveld
Peter W
PW
Center for Primary Care and Outcomes Research, University, 117 Encina Commons, Stanford, Calif 94305-6019, USA. petegro@healthpolicy.stanford.edu
Heidenreich
Paul A
PA
Garber
Alan M
AM
D000368:Aged; D044383:Black People; D015331:Cohort Studies; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality* / Q000628:therapy; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000592:standards / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis; D017741:Survivors / Q000145:classification / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D044465:White People; D001741:Black or African American