| Understanding racial variation in the use of coronary revascularization procedures: the role of clinical factors. | |
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MedLine Citation:
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PMID: 10809037 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Black patients undergo coronary artery bypass grafting and percutaneous transluminal coronary angioplasty less often than white patients. It is unclear how racial differences in clinical factors contribute to this variation. METHODS: A retrospective cohort study was performed of 666 male patients (326 blacks and 340 whites), admitted to 1 of 6 Veterans Affairs hospitals from October 1, 1989, to September 30, 1995, with acute myocardial infarction or unstable angina who underwent cardiac catheterization. The primary comparison was whether racial differences in percutaneous transluminal coronary angioplasty and coronary artery bypass grafting rates persisted after stratifying by clinical appropriateness of the procedure, measured by the appropriateness scale developed by the RAND Corporation, Santa Monica, Calif. RESULTS: Whites more often than blacks underwent a revascularization procedure (47% vs 28%). There was substantial variation in black-white odds ratios within different appropriateness categories. Blacks were significantly less likely to undergo percutaneous transluminal coronary angioplasty (odds ratio, 0.30; 95% confidence interval, 0.14-0.63 [P<.01]) when the indication was rated "equivocal." Similarly, blacks were less likely to undergo coronary artery bypass grafting (odds ratio, 0.44; 95% confidence interval, 0.23-0.86 [P<.01]) when only coronary artery bypass grafting was indicated as "appropriate and necessary." Differences in comorbidity or use of cigarettes or alcohol did not explain these variations. Using administrative data from the Veterans Health Administration, we found no differences in 1-year (5.2% vs 7.4%) and 5-year (23.3% vs 26.2%) mortality for blacks vs whites. CONCLUSION: Among patients with acute myocardial infarction or unstable angina, variation in clinical factors using RAND appropriateness criteria for procedures explained some, but not all, racial differences in coronary revascularization use. |
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Authors:
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J Conigliaro; J Whittle; C B Good; B H Hanusa; L J Passman; R P Lofgren; R Allman; P A Ubel; M O'Connor; D S Macpherson |
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Publication Detail:
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Type: Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S. |
Journal Detail:
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Title: Archives of internal medicine Volume: 160 ISSN: 0003-9926 ISO Abbreviation: Arch. Intern. Med. Publication Date: 2000 May |
Date Detail:
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Created Date: 2000-05-30 Completed Date: 2000-05-30 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0372440 Medline TA: Arch Intern Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1329-35 Citation Subset: AIM; IM |
Affiliation:
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Section of General Internal Medicine, VA Pittsburgh Health Care System and Center for Research on Health Care, University of Pittsburgh, PA 15240, USA. jcct@pitt.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult African Americans / statistics & numerical data* Angina, Unstable / surgery, therapy* Angioplasty, Transluminal, Percutaneous Coronary / utilization* Coronary Artery Bypass / utilization* European Continental Ancestry Group / statistics & numerical data* Humans Male Myocardial Infarction / surgery, therapy* Physician's Practice Patterns* Retrospective Studies |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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