title: Racial disparities in the use of cardiac revascularization: does local hospital capacity matter?
abstract: OBJECTIVE
  To assess the extent to which the observed racial disparities in cardiac revascularization use can be explained by the variation across counties where patients live, and how the within-county racial disparities is associated with the local hospital capacity.
  
  
  METHODS
  Administrative data from Pennsylvania Health Care Cost Containment Council (PHC4) between 1995 and 2006.
  
  
  METHODS
  The study sample included 207,570 Medicare patients admitted to hospital for acute myocardial infarction (AMI). We identified the use of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) procedures within three months after the patient's initial admission for AMI. Multi-level hierarchical models were used to determine the extent to which racial disparities in procedure use were attributable to the variation in local hospital capacity.
  
  
  RESULTS
  Blacks were less likely than whites to receive CABG (9.1% vs. 5.8%; p<0.001) and PCI (15.7% vs. 14.2%; p<0.001). The state-level racial disparity in use rate decreases for CABG, and increases for PCI, with the county adjustment. Higher number of revascularization hospitals per 1,000 AMI patients was associated with smaller within-county racial differences in CABG and PCI rates. Meanwhile, very low capacity of catheterization suites and AMI hospitals contributed to significantly wider racial gap in PCI rate.
  
  
  CONCLUSIONS
  County variation in cardiac revascularization use rates helps explain the observed racial disparities. While smaller hospital capacity is associated with lower procedure rates for both racial groups, the impact is found to be larger on blacks. Therefore, consequences of fewer medical resources may be particularly pronounced for blacks, compared with whites.
authors.affiliation: Department of Health Policy, George Washington University, Washington, District of Columbia, United States of America. suhuili@gwu.edu
authors.forename: Suhui
authors.initials: S
authors.lastname: Li
authors.forename: Arnold
authors.initials: A
authors.lastname: Chen
authors.forename: Katherine
authors.initials: K
authors.lastname: Mead
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D044383:Black People; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D014481:United States; D044465:White People; D001741:Black or African American