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Racial Differences in Cardiac Revascularization Rates: Does “Overuse” Explain Higher Rates among White Patients?
Abstract
Background Coronary artery bypass graft (CABG) surgery and percutaneous transluminal coronary angioplasty (PTCA) are well-established treatments for symptomatic coronary artery disease. Previous studies have documented racial differences in rates of use of these cardiac revascularization procedures. Other studies suggest that these procedures are overused: that is, they are done for patients with clinically inappropriate indications. Objective To test the hypothesis that the higher rate of cardiac revascularization among white patients is associated with a higher prevalence of overuse (revascularization for clinically inappropriate indications) among white patients than among African-American patients. Design Observational cohort study using Medicare claims and medical record review. Setting 173 hospitals in five U.S. states. Participants A stratified, weighted, random sample of 3960 Medicare beneficiaries who underwent coronary angiography during 1991 and 1992; 1692 of these patients underwent 1711 revascularization procedures within 90 days. Measurements The proportion of CABG and PTCA procedures rated appropriate, uncertain, and inappropriate according to RAND criteria, and the multivariate odds of undergoing inappropriate revascularization among African-American patients and white patients. Results After angiography, rates of PTCA (23% vs. 19%) and CABG surgery (29% vs. 17%) were significantly higher among white patients than among African-American patients. The respectiv…
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“one study indicated that whites were more likely to receive inappropriate angiography, although the racial difference in rates of inappropriate percutaneous transluminal coronary angioplasty was not sufficiently large to account for more than a small fraction of the substantial disparities in rates of revascularization between white patients and African-American patients [7].”
From Unequal treatment: report of the institute of medicine on racial and ethnic disparities in healthcare (2003) · cites this paper as [7]
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Braveman, P. A., Cubbin, C., Egerter, S., Williams, D. R., & Pamuk, E. (2010) · American Journal of Public Health · doi:10.2105/ajph.2009.166082 · Cited by 1,548
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Racial disparities in diabetes care processes, outcomes, and treatment intensity.
Heisler, M., Smith, D. M., Hayward, R. A., Krein, S. L., & Kerr, E. A. (2003) · Medical Care · doi:10.1097/01.mlr.0000093421.64618.9c · Cited by 231
Misgivings of medicine: African Americans' skepticism of psychiatric medication
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Metadata
- Authors
- Schneider, E. C., Leape, L. L., Weissman, J. S., Piana, R. N., Gatsonis, C., & Epstein, A. M.
- Affiliations
- Brigham and Women's Hospital (US)
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2001-09-04
- Volume
- 135
- Issue
- 5
- Pages
- 328-337
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2082186343
- Cited by
- 151
- References
- 1
- Citations by year
- 2026: 1 · 2024: 4 · 2023: 4 · 2022: 2 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 3 · 2017: 2 · 2016: 1 · 2015: 5 · 2014: 6 · 2013: 7 · 2012: 5
- FWCI
- 12.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (5-RO-HS07098-02S1)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Keywords
- racial disparities, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, overuse, African American patients, Caucasian patients, Medicare beneficiaries, coronary artery disease, sex differences, coronary angiography, hospital utilization, health care utilization disparities
- MeSH terms
- Aged, Coronary Artery Bypass, Black or African American, Coronary Disease, Female, Medicare, Health Services Misuse, Humans, Income, Male, Sex Factors, United States, Cohort Studies, Angioplasty, Balloon, Coronary, Odds Ratio, Black People, White People
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- Schneider, E. C., Leape, L. L., Weissman, J. S., Piana, R. N., Gatsonis, C., & Epstein, A. M. (2001). Racial Differences in Cardiac Revascularization Rates: Does “Overuse” Explain Higher Rates among White Patients? Annals of Internal Medicine. https://doi.org/10.7326/0003-4819-135-5-200109040-00009
