Coronary revascularization at specialty cardiac hospitals and peer general hospitals in black Medicare beneficiaries.
BACKGROUND
Critics have raised concerns that specialty cardiac hospitals exacerbate racial disparities in cardiovascular care, but empirical data are limited.


RESULTS
We used administrative data from the Medicare Provider and Analysis Review Part A and Provider-of-Service files from 2002 to 2005. Multivariable logistic regression models were constructed to examine the likelihood of black Medicare patients being admitted to a cardiac hospital for coronary revascularization when compared with white patients within the same healthcare referral region after accounting for geographic proximity to the nearest hospitals, procedural acuity, and comorbidities. We identified 35 309 patients who underwent coronary artery bypass grafting in 18 healthcare referral regions and 94,525 patients who underwent percutaneous coronary intervention in 20 healthcare referral regions where cardiac hospitals performed these procedures. Patients at cardiac hospitals were more likely to be men and white and have less comorbidity than those at general hospitals. The likelihood of black patients undergoing coronary revascularization at a cardiac hospital was significantly lower for coronary artery bypass grafting (adjusted odds ratio, 0.67; P=0.01) and percutaneous coronary intervention (adjusted odds ratio, 0.63; P<0.0001). However, this relationship was substantially attenuated among black patients living in close proximity (ie, within 10 miles) to cardiac hospitals (adjusted odds ratio for coronary artery bypass grafting, 0.95; P=0.75; adjusted odds ratio for percutaneous coronary intervention, 0.78; P=0.01).


CONCLUSIONS
Black patients were significantly less likely to be admitted at cardiac hospitals for coronary revascularization. Precise reasons for these findings are unclear but suggest complex associations between race and geography in decisions about where to receive care.
Nallamothu
Brahmajee K
BK
Health Services Research and Development Center of Excellence, Ann Arbor VA Medical Center, Ann Arbor, Mich, USA. bnallamo@umich.edu
Lu
Xin
X
Vaughan-Sarrazin
Mary S
MS
Cram
Peter
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D002300:Cardiac Care Facilities; D002648:Child; D002675:Child, Preschool; D003324:Coronary Artery Disease / Q000191:economics / Q000208:ethnology* / Q000628:therapy*; D005260:Female; D006769:Hospitals, General; D006801:Humans; D007342:Insurance Benefits; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000191:economics / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data; D014481:United States; D044465:White People; D001741:Black or African American