Neighborhood socioeconomic and racial disparities in angiography and coronary revascularization: the ARIC surveillance study.
OBJECTIVE
Disparities in the receipt of angiography and subsequent coronary revascularization have not been well-studied.


METHODS
We estimated prevalence ratios and 95% confidence intervals (PR, 95% CIs) for the association between neighborhood-level income (nINC) and receipt of angiography; and among those undergoing angiography, receipt of revascularization procedures, among 9941 hospitalized myocardial infarction patients under epidemiologic surveillance by the Atherosclerosis Risk in Communities Study (1993-2002).


RESULTS
In analyses by tertile of nINC controlling for age, study community, gender, and year, compared with white patients from high nINC areas, black patients from low nINC (0.60, 0.54-0.66) and medium nINC (0.70, 0.60-0.78) areas, as well as white patients from low nINC areas (0.83, 0.75-0.91) were less likely to receive angiography, whereas black patients from high nINC and white patients from medium nINC areas were not. Associations were attenuated, but persisted, after we controlled for event severity, medical history, receipt of Medicaid, and hospital type. Compared with high nINC white patients, black patients were less likely, and white patients were as likely, to undergo cardiac revascularization, given receipt of an angiogram.


CONCLUSIONS
Black and lower nINC patients were less likely to undergo angiography than were white patients and those from higher nINC areas. Among those receiving angiography, race, but not nINC, gradients persisted.
SRA International, Durham, NC 27713, USA.
Kathryn M
KM
Rose
Randi E
RE
Foraker
Gerardo
G
Heiss
Wayne D
WD
Rosamond
Chirayath M
CM
Suchindran
Eric A
EA
Whitsel
D000328:Adult; D000368:Aged; D044383:Black People / Q000706:statistics & numerical data*; D015897:Comorbidity; D016001:Confidence Intervals; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006801:Humans; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American