title: Early results of Massachusetts healthcare reform on racial, ethnic, and socioeconomic disparities in cardiovascular care.
abstract: BACKGROUND
  Insured adults receive invasive cardiovascular procedures more frequently than uninsured adults. We examined the impact of healthcare reform in Massachusetts on use of coronary revascularization procedures and in-hospital and 1-year mortality by race/ethnicity, education, and sex.
  
  
  RESULTS
  Using hospital claims data, we compared differences in coronary revascularization rates (coronary artery bypass grafting or percutaneous coronary intervention) and in-hospital mortality by race/ethnicity, education, and sex among Massachusetts residents aged 21 to 64 years hospitalized with a principal discharge diagnosis of ischemic heart disease before (November 1, 2004, to July 31, 2006) and after (December 1, 2006, to September 30, 2008) reform; 1-year mortality was calculated for those undergoing revascularization. Adjusted logistic regression assessed 24 216 discharges before reform and 20 721 discharges after reform. Blacks had 30% lower odds of receiving coronary revascularization than whites in the prereform period. Compared with whites in the postreform period, blacks (odds ratio=0.73; 95% confidence interval, 0.63-0.84) and Hispanics (odds ratio= 0.84; 95% confidence interval, 0.74-0.97) were less likely and Asians (odds ratio=1.29; 95% confidence interval, 1.01-1.65) were more likely to receive coronary revascularization. Patients living in more educated communities, men, and persons with private insurance were more likely to receive coronary revascularization before and after reform. Compared with the prereform period, the adjusted odds of in-hospital mortality were higher in patients living in less-educated communities in the postreform period. No differences in 1-year mortality by race/ethnicity, education, or sex for revascularized patients were observed before or after reform.
  
  
  CONCLUSIONS
  Reducing insurance barriers to receipt of coronary revascularization procedures has not yet eliminated preexisting demographic and educational disparities in access to these procedures.
authors.affiliation: From the Divisions of Cardiovascular Medicine and Preventive Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (M.A.A., F.R.); Division of General Medicine, Brigham and Women's Hospital, Boston, MA (J.Z.A.); Department of Health Care Policy, Harvard Medical School, Boston, MA (J.Z.A., A.L., S.T.N.); Lahey Clinic, Lahey, MA (F.R.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.T.N.); Institute of Healthcare Policy, University of Michigan, Ann Arbor (J.Z.A.); and Division of Cardiovascular Medicine at Howard University and Howard University Hospital, Washington, DC (A.J.). michelle.albert@howard.edu.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Albert
authors.affiliation: From the Divisions of Cardiovascular Medicine and Preventive Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (M.A.A., F.R.); Division of General Medicine, Brigham and Women's Hospital, Boston, MA (J.Z.A.); Department of Health Care Policy, Harvard Medical School, Boston, MA (J.Z.A., A.L., S.T.N.); Lahey Clinic, Lahey, MA (F.R.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.T.N.); Institute of Healthcare Policy, University of Michigan, Ann Arbor (J.Z.A.); and Division of Cardiovascular Medicine at Howard University and Howard University Hospital, Washington, DC (A.J.).
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
authors.affiliation: From the Divisions of Cardiovascular Medicine and Preventive Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (M.A.A., F.R.); Division of General Medicine, Brigham and Women's Hospital, Boston, MA (J.Z.A.); Department of Health Care Policy, Harvard Medical School, Boston, MA (J.Z.A., A.L., S.T.N.); Lahey Clinic, Lahey, MA (F.R.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.T.N.); Institute of Healthcare Policy, University of Michigan, Ann Arbor (J.Z.A.); and Division of Cardiovascular Medicine at Howard University and Howard University Hospital, Washington, DC (A.J.).
authors.forename: Treacy S
authors.initials: TS
authors.lastname: Silbaugh
authors.affiliation: From the Divisions of Cardiovascular Medicine and Preventive Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (M.A.A., F.R.); Division of General Medicine, Brigham and Women's Hospital, Boston, MA (J.Z.A.); Department of Health Care Policy, Harvard Medical School, Boston, MA (J.Z.A., A.L., S.T.N.); Lahey Clinic, Lahey, MA (F.R.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.T.N.); Institute of Healthcare Policy, University of Michigan, Ann Arbor (J.Z.A.); and Division of Cardiovascular Medicine at Howard University and Howard University Hospital, Washington, DC (A.J.).
authors.forename: Ann
authors.initials: A
authors.lastname: Lovett
authors.affiliation: From the Divisions of Cardiovascular Medicine and Preventive Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (M.A.A., F.R.); Division of General Medicine, Brigham and Women's Hospital, Boston, MA (J.Z.A.); Department of Health Care Policy, Harvard Medical School, Boston, MA (J.Z.A., A.L., S.T.N.); Lahey Clinic, Lahey, MA (F.R.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.T.N.); Institute of Healthcare Policy, University of Michigan, Ann Arbor (J.Z.A.); and Division of Cardiovascular Medicine at Howard University and Howard University Hospital, Washington, DC (A.J.).
authors.forename: Fred
authors.initials: F
authors.lastname: Resnic
authors.affiliation: From the Divisions of Cardiovascular Medicine and Preventive Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (M.A.A., F.R.); Division of General Medicine, Brigham and Women's Hospital, Boston, MA (J.Z.A.); Department of Health Care Policy, Harvard Medical School, Boston, MA (J.Z.A., A.L., S.T.N.); Lahey Clinic, Lahey, MA (F.R.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.T.N.); Institute of Healthcare Policy, University of Michigan, Ann Arbor (J.Z.A.); and Division of Cardiovascular Medicine at Howard University and Howard University Hospital, Washington, DC (A.J.).
authors.forename: Aryana
authors.initials: A
authors.lastname: Jacobs
authors.affiliation: From the Divisions of Cardiovascular Medicine and Preventive Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (M.A.A., F.R.); Division of General Medicine, Brigham and Women's Hospital, Boston, MA (J.Z.A.); Department of Health Care Policy, Harvard Medical School, Boston, MA (J.Z.A., A.L., S.T.N.); Lahey Clinic, Lahey, MA (F.R.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.T.N.); Institute of Healthcare Policy, University of Michigan, Ann Arbor (J.Z.A.); and Division of Cardiovascular Medicine at Howard University and Howard University Hospital, Washington, DC (A.J.).
authors.forename: Sharon-Lise T
authors.initials: SL
authors.lastname: Normand
mesh_terms: D000328:Adult; D001026:Coronary Artery Bypass / Q000401:mortality / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000208:ethnology* / Q000401:mortality / Q000628:therapy; D004522:Educational Status; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D018166:Health Care Reform / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000401:mortality / Q000706:statistics & numerical data*; D015995:Prevalence; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: coronary; ethnicity; gender; race; socioeconomic status
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