Disparities in the receipt of cardiac revascularization procedures between blacks and whites: an analysis of secular trends.
BACKGROUND
Mortality rates for coronary heart disease (CHD) have declined markedly since the early 1970s. However, CHD remains the number one cause of death in the United States. The decline in mortality has been attributed to declines in CHD risk factors (tobacco use, hypertension) and the increase in protective behaviors (exercise, weight control). Medical interventions may have also contributed to the decline in mortality. Despite these declines in mortality, racial disparities persist between Blacks and Whites. The purpose of this study was to examine the differences in receipt of cardiac catheterization, percutaneous transluminal coronary angioplasty, and coronary artery bypass graft.


METHODS
Data from the National Hospital Discharge Survey were used for the analysis. Patients who were Black or White and > or = 40 years of age were included. Independent variables included age at discharge, sex, race, and insurance coverage. Multivariate logistic regression was used to derive odds ratios for the receipt of the three procedures by age group, sex, insurance type, and race.


RESULTS
Significant differences (P < .05) in the odds of receipt of all of cardiac catheterization, percutaneous transluminal coronary angioplasty, and coronary artery bypass graft were found by age group, insurance type, sex, and race. While the disparities persisted from 1979 to 2004, the magnitude of the differences decreased during this time period.


CONCLUSIONS
Disparities by race, sex, and insurance type existed in the receipt of three cardiac procedures. Although differences are narrowing over time, further in-depth studies are needed to elucidate the patient, physician, and healthcare system factors associated with the disparity in receipt of these beneficial procedures.
Brown
C Perry
CP
Institute of Public Health, Division of Pharmacy Practice (AT), College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, Florida, USA. perry.brown@famu.edu
Ross
Levi
L
Lopez
Ivette
I
Thornton
Angela
A
Kiros
Gebre-Egziabher
GE
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D044383:Black People / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014600:Utilization Review; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American