title: Racial disparity in access to cardiac intensive care over 20 years.
abstract: OBJECTIVE
  The purposes of this article are: (1) to systematically examine racial disparities in access to and use of cardiac care units (CCUs) in acute-care hospitals; and (2) to assess racial differences in post-hospital mortality following CCU stays.
  
  
  METHODS
  Data from the National Health and Nutrition Examination Survey I: Epidemiologic Follow-up Study of adults aged 25 and older at baseline are analyzed to track CCU use and survival after hospitalization over 20 years (N=4227). Estimates are derived from Cox proportional-hazards models with time-dependent covariates and from negative binomial and tobit regression analyses. All analyses adjust for disease severity, hospitalization history, and resources.
  
  
  RESULTS
  Black adults were less likely than White adults to be admitted to a CCU, even after adjusting for morbidities, health behaviors, previous hospitalization experience, and socioeconomic status. Comparing Black and White adults admitted to CCUs, Black adults spent fewer days and a smaller proportion of their hospital stay in CCUs. Black adults also had fewer CCU stays over the 20-year period and were more likely to die post-discharge, although the latter result was mediated by disease severity.
  
  
  CONCLUSIONS
  Higher morbidity, lower admission rates, fewer stays, and shorter stays reveal that racial inequality is far-reaching and exists even in such highly-specialized units as CCUs. The fact that Black individuals' greater post-discharge mortality was mediated by disease severity illustrated that even among high-risk individuals, the accumulation of morbidity factors (beyond cardiac problems) is a salient concern. Overall findings demonstrate that the accumulation of disadvantage for Black adults is not confined to discretionary medical measures, but also exists in critical care for serious health problems.
authors.affiliation: Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA. tshippee@umn.edu
authors.forename: Tetyana P
authors.initials: TP
authors.lastname: Shippee
authors.forename: Kenneth F
authors.initials: KF
authors.lastname: Ferraro
authors.forename: Roland J
authors.initials: RJ
authors.lastname: Thorpe
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D016507:Cardiology Service, Hospital / Q000706:statistics & numerical data*; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000639:trends; D054625:Healthcare Disparities; D006801:Humans; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011446:Prospective Studies; D044469:Racial Groups; D014481:United States; D044465:White People; D055815:Young Adult