Can characteristics of a health care system mitigate ethnic bias in access to cardiovascular procedures? Experience from the military health services system
Open accessAbstract
Objectives This study sought to investigate the independent effect of ethnicity on the utilization of invasive cardiac procedures after acute myocardial infarction (AMI). Background The precise role of ethnicity in access to cardiovascular procedures is unknown, particularly because of difficulty in isolating ethnicity from financial and other socioeconomic factors. We conducted a retrospective analysis of the use of cardiac catheterization and coronary revascularization procedures after AMI in military health care beneficiaries. The Military Health Services System (MHSS) ensures equal access to care in an environment without financial incentives for procedural utilization; furthermore, socioeconomic differences between patients beyond ethnicity are minimized. Methods Data were analyzed from the Civilian External Peer Review Program representing abstracted chart reviews from 125 military health care facilities worldwide for all patients (1,208 white; 233 nonwhite [155 black]) with the principal or secondary diagnosis of AMI from March to September 1993. Results Rates of cardiac catheterization were similar in white and nonwhite patients (34.8 vs. 39.1%, p = 0.21). After controlling for age, gender, cardiovascular risk factors and AMI variables, including infarct size and other risk markers, there were no differences in the use of this procedure during the AMI admission in comparisons of white versus nonwhite patients (estimated odds ratio [OR] 0.96, 95% confidence interval [CI] 0.69 to 1.34) and white versus black patients (OR 1.19, 95% CI 0.80 to 1.78). However, white patients were significantly more likely than nonwhite patients to be "considered" for future cardiac catheterization (OR 1.77, 95% CI 1.19 to 2.61). Coronary revascularization within 180 days was not significantly affected by race in white versus nonwhite (OR 0.90, 95% CI 0.59 to 1.39) and white versus black patients (OR 1.11, 95% CI 0.65 to 1.89). Outcomes (30- and 180-day mortality and readmission rates) were similar for all race groups. Conclusions There is a limited relation between ethnicity and the use of invasive cardiac procedures in the MHSS. These data raise the promise that characteristics of a health care system can mitigate ethnic bias in medicine.
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A very large national study with patients from the National Registry of Myocardial Infarction 2, comprising 275,000 patients, and prospective controlled studies revealed clear differences in the likelihood of receipt of procedures during nearly every phase of diagnosis and treatment of coronary artery disease, with minority patients usually coming up short.
“the very large national study with patients from the National Registry of Myocardial Infarction 2, comprising 275,000 patients [5], and the prospective controlled studies [6] revealed clear differences in the likelihood of receipt of procedures during nearly every phase of diagnosis and treatment of coronary artery disease, with minority patients usually coming up short.”
From Unequal treatment: report of the institute of medicine on racial and ethnic disparities in healthcare (2003) · cites this paper as [5]
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Nelson, A. R. (2003) · The Annals of Thoracic Surgery · doi:10.1016/s0003-4975(03)01205-0 · Cited by 166 · see citing works
- Authors
- Taylor, A. J., Meyer, G. S., Morse, R. W., & Pearson, C. E.
- Affiliations
- Uniformed Services University of the Health Sciences (US)
- Corresponding author
- Taylor, Allen J
- ORCID
- Meyer, Gregg S
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 1997-10
- Volume
- 30
- Issue
- 4
- Pages
- 901-907
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W1966343556
- Cited by
- 51
- References
- 0
- Citations by year
- 2022: 1 · 2019: 1 · 2015: 1 · 2014: 1 · 2013: 1
- FWCI
- 1.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Keywords
- ethnic prejudice, health care access, acute myocardial infarction, cardiac catheterization, coronary revascularization, military health services, socioeconomic factors, health care system characteristics, Black patients, non-white patients, equal access to health care
- MeSH terms
- Aged, Black or African American, Female, Health Services Accessibility, Cardiac Catheterization, Hospitals, Military, Humans, Male, Middle Aged, Myocardial Infarction, Myocardial Revascularization, Prejudice, Retrospective Studies, Risk Factors, United States, Odds Ratio, Treatment Outcome, White People
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