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Cited by 550Coronary Interventions and DiagnosticsCardiac Imaging and DiagnosticsHealth disparities and outcomes

Racial Variation in the Use of Coronary-Revascularization Procedures — Are the Differences Real? Do They Matter?

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Peterson, Eric D., Shaw, Linda K., DeLong, Elizabeth R., Pryor, David B., Califf, Robert M., Mark, Daniel B.·1997·New England Journal of Medicine
DOI 10.1056/nejm199702133360706
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Abstract

BACKGROUND: Studies have reported that blacks undergo fewer coronary-revascularization procedures than whites, but it is not clear whether the clinical characteristics of the patients account for these differences or whether they indicate underuse of the procedures in blacks or overuse in whites. METHODS: In a study at Duke University of 12,402 patients (10.3 percent of whom were black) with coronary disease, we calculated unadjusted and adjusted rates of angioplasty and bypass surgery in blacks and whites after cardiac catheterization. We also examined patterns of treatment after stratifying the patients according to the severity of disease, angina status, and estimated survival benefit due to revascularization. Finally, we compared five-year survival rates in blacks and whites. RESULTS: After adjustment for the severity of disease and other characteristics, blacks were 13 percent less likely than whites to undergo angioplasty and 32 percent less likely to undergo bypass surgery. The adjusted black:white odds ratios for receiving these procedures were 0.87 (95 percent confidence interval, 0.73 to 1.03) and 0.68 (95 percent confidence interval, 0.56 to 0.82), respectively. The racial differences in rates of bypass surgery persisted among those with severe anginal symptoms (31 percent of blacks underwent surgery, vs. 45 percent of whites, P<0.001) and among those predicted to have the greatest survival benefit from revascularization (42 percent vs. 61 percent, P<0.001). Finally, unadjusted and adjusted rates of survival for five years were significantly lower in blacks than in whites. CONCLUSIONS: Blacks with coronary disease were significantly less likely than whites to undergo coronary revascularization, particularly bypass surgery - a difference that could not be explained by the clinical features of their disease. The differences in treatment were most pronounced among those predicted to benefit the most from revascularization. Since these differences also correlated with a lower survival rate in blacks, we conclude that coronary revascularization appears to be underused in blacks.

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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 [6]

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Research works printed but not linked: 32

  1. Gillum RF. Coronary artery bypass surgery and coronary angiography in the United States, 1979-1983. Am Heart J 1987;113:1255-60.
  2. McBean AM, Warren JL, Babish JD. Continuing differences in the rates of percutaneous transluminal coronary angioplasty and coronary artery by- pass graft surgery between elderly black and white Medicare beneficiaries. Am Heart J 1994;127:287-95.
  3. Goldberg KC, Hartz AJ, Jacobsen SJ, Krakauer H, Rimm AA. Racial and community factors influencing coronary artery bypass graft surgery rates for all 1986 Medicare patients. JAMA 1992;267:1473-7.
  4. Wenneker MB, Epstein AM. Racial inequalities in the use of procedures for patients with ischemic heart disease in Massachusetts. JAMA 1989;261: 253-7.
  5. Ford E, Cooper RS, Castaner A, Simmons BE, Mar M. Coronary arte- riography and coronary bypass survey among whites and other racial groups relative to hospital-based incidence rates for coronary artery disease: findings from NHDS. Am J Public Health 1989;79:437-40.
  6. Hannan EL, Kilburn H Jr, O'Donnell JF, Lukacik G, Shields EP. Inter- racial access to selected cardiac procedures for patients hospitalized with coronary artery disease in New York State. Med Care 1991;29:430-41.
  7. Gittelsohn KG, Halpern J, Sanchez RL. Income, race, and surgery in Maryland. Am J Public Health 1991;81:1435-41.
  8. Udvarhelyi S, Gatsonis C, Epstein AM, Pashos CL, Newhouse JP, McNeil BJ. Acute myocardial infarction in the Medicare population: proc- ess of care and clinical outcomes. JAMA 1992;268:2530-6.
  9. Johnson PA, Lee TH, Cook EF, Rouan GW, Goldman L. Effect of race on the presentation and management of patients with acute chest pain. Ann Intern Med 1993;118:593-601.
  10. Peterson ED, Wright SM, Daley J, Thibault GE. Racial variation in cardiac procedure use and survival following acute myocardial infarction in the Department of Veterans Affairs. JAMA 1994;271:1175-80.
  11. Maynard C, Litwin PE, Martin JS, et al. Characteristics of black pa- tients admitted to coronary care units in metropolitan Seattle: results from the Myocardial Infarction Triage and Intervention Registry (MITI). Am J Cardiol 1991;67:18-23.
  12. Whittle J, Conigliaro J, Good CB, Lofgren RP. Racial differences in the use of invasive cardiovascular procedures in the Department of Veterans Affairs medical system. N Engl J Med 1993;329:621-7.
  13. Mirvis DM, Burns R, Gaschen L, Cloar FT, Graney M. Variation in utilization of cardiac procedures in the Department of Veterans Affairs health care system: effect of race. J Am Coll Cardiol 1994;24:1297-304.
  14. Giles WH, Anda RF, Casper ML, Escobedo LG, Taylor HA. Race and sex differences in rates of invasive cardiac procedures in US hospitals: data from the National Hospital Discharge Survey. Arch Intern Med 1995;155: 318-24.
  15. Stone PH, Thompson B, Anderson HV, et al. Influence of race, sex, and age on management of unstable angina and non-Q-wave myocardial infarction: the TIMI III registry. JAMA 1996;275:1104-12.
  16. Jollis JG, Ancukiewicz M, DeLong ER, Pryor DB, Muhlbaier LH, Mark DB. Discordance of databases designed for claims payment versus clinical information systems: implications for outcomes research. Ann In- tern Med 1993;119:844-50.
  17. Rosati RA, McNeer JF, Starmer CF, Mittler BS, Morris JJ Jr, Wallace AG. A new information system for medical practice. Arch Intern Med 1975;135:1017-24.
  18. Harris PJ, Harrell FE Jr, Lee KL, Behar VS, Rosati RA. Survival in medically treated coronary artery disease. Circulation 1979;60:1259- 69.
  19. Pryor DB, Harrell FE Jr, Lee KL, Califf RM, Rosati RA. Estimating the likelihood of significant coronary artery disease. Am J Med 1983;75: 771-80.
  20. Harrell FE Jr, Califf RM, Pryor DB, Lee KL, Rosati RA. Evaluating the yield of medical tests. JAMA 1982;247:2543-6.
  21. Pryor DB, Bruce RA, Chaitman BR, et al. Determination of prognosis in patients with ischemic heart disease. J Am Coll Cardiol 1989;14:1016- 25.
  22. Califf RM, Harrell FE Jr, Lee KL, et al. The evolution of medical and surgical therapy for coronary artery disease: a 15-year perspective. JAMA 1989;261:2077-86.
  23. Trask N, Califf RM, Conley MJ, et al. Accuracy and interobserver vari- ability of coronary cineangiography: a comparison with postmortem eval- uation. J Am Coll Cardiol 1984;3:1145-54.
  24. Gersh BJ, Kronmal RA, Frye RL, et al. Coronary arteriography and coronary artery bypass surgery: morbidity and mortality in patients ages 65 years or older: a report from the Coronary Artery Surgery Study. Circula- tion 1983;67:483-91.
  25. Mark DB, Nelson CL, Califf RM, et al. Continuing evolution of ther- apy for coronary artery disease: initial results from the era of coronary an- gioplasty. Circulation 1994;89:2015-25.
  26. Yusuf S, Zucker D, Peduzzi P, et al. Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lan- cet 1994;344:563-70. [Erratum, Lancet 1994;344:1446.]
  27. Maynard C, Fisher LD, Passamani ER, Pullum T. Blacks in the Coro- nary Artery Surgery Study (CASS): race and clinical decision making. Am J Public Health 1986;76:1446-8.
  28. Schecter AD, Goldschmidt-Clermont PJ, McKee G, et al. Influence of gender, race, and education on patient preferences and receipt of cardiac catheterizations among coronary care unit patients. Am J Cardiol 1996;78: 996-1001.
  29. White EH. Giving health care to minority patients. Nurs Clin North Am 1977;12:27-40.
  30. Blendon RJ, Aiken LH, Freeman HE, Corey CR. Access to medical care for black and white Americans: a matter of continuing concern. JAMA 1989;261:278-81.
  31. Wilson-Ford V. Health-protective behaviors of rural black elderly women. Health Soc Work 1992;17:28-36.
  32. Caldwell SH, Popenoe R. Perceptions and misperceptions of skin col- or. Ann Intern Med 1995;122:614-7.

Cited by

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Authors
Peterson, E. D., Shaw, L. K., DeLong, E. R., Pryor, D. B., Califf, R. M., & Mark, D. B.
Affiliations
  • Duke Medical Center (US)
  • Duke University (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
1997-02-13
Volume
336
Issue
7
Pages
480-486
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm199702133360706
OpenAlex
W2007606103
Cited by
550
References
0
Citations by year
2026: 4 · 2025: 4 · 2024: 4 · 2023: 10 · 2022: 5 · 2021: 4 · 2020: 4 · 2019: 5 · 2018: 6 · 2017: 10 · 2016: 5 · 2015: 9 · 2014: 11 · 2013: 15 · 2012: 13
FWCI
31.94
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Funders
  • National Institutes of Health (5p50hl017670-19)
  • Agency for Healthcare Research and Quality (HS-05635, HS06503)
  • National Heart, Lung, and Blood Institute (HL17670)
Topics
  • Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
  • Social Sciences › Health › Health disparities and outcomes
Keywords
racial disparities, coronary revascularization, coronary angioplasty, coronary artery bypass grafting, coronary artery disease, Black patients, underuse of care, angina severity, cardiac catheterization
MeSH terms
Coronary Artery Bypass, Black or African American, Coronary Disease, Hospitals, University, Humans, North Carolina, Practice Patterns, Physicians', Prognosis, Angioplasty, Balloon, Coronary, Survival Rate, Logistic Models, Patient Selection, Black People, White People

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