Changes in racial disparities in access to coronary artery bypass grafting surgery between the late 1990s and early 2000s.
BACKGROUND
Racial disparities in medical care in the United States are pervasive and persistent. Minorities, African American patients in particular, have lower utilization rates for coronary artery bypass graft surgery (CABG) and, compared with white patients, they receive care from surgeons with worse records of performance.


OBJECTIVE
We sought to examine the persistence of disparities in CABG care (overall access to surgery and access to high-quality surgeons) in recent years and the potential causes for declining disparities.


METHODS
We undertook a retrospective analysis of data comparing access to CABG surgery and access to high-quality cardiac surgeons for white and black patients in the late 1990s and the early 2000s. Data used included the Medicare inpatient and physician part B claims and the New York State Cardiac Surgery Reports. A total of 24,087 Medicare fee-for-service patients undergoing CABG surgery between the years 1997-1999 and 23,048 patients undergoing CABG surgery between the years of 2001-2003 in New York State were studied. We measured the number of patients undergoing surgery by race and quality of surgeons measured by the surgeons' risk-adjusted mortality rates.


CONCLUSIONS
Disparities have declined between the 2 periods. The decline seems to be associated with freed surgical capacity among all surgeons, although other factors may also present barriers, especially in terms of overall access to surgery. Despite the decline in disparities, gaps in care received by white and black patients remain.
Mukamel
Dana B
DB
Center for Health Policy Research, University of California-Irvine, 111 Academy Suite, Irvine, CA 92697, USA. dmukamel@uci.edu
Weimer
David L
DL
Buchmueller
Thomas C
TC
Ladd
Heather
H
Mushlin
Alvin I
AI
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D001026:Coronary Artery Bypass / Q000639:trends*; D018588:Fee-for-Service Plans; D005260:Female; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D009518:New York; D011787:Quality of Health Care / Q000639:trends*; D012189:Retrospective Studies; D020379:Risk Adjustment; D014481:United States; D044465:White People / Q000706:statistics & numerical data*