The authors examined discharge abstracts collected by the Hospital Services Cost Review Commission (HSCRC) for the period from 1985 to 1987. Common surgical and medical hospital admission rates for Maryland residents were assessed, and the role of race and income was examined. The results revealed that, the more discretionary the procedure, the lower the relative incidence among Blacks. In contrast to the population rates for discretionary orthopedic, vascular, and laryngologic surgery, admission rates for most medical indications decline with increasing income levels and are elevated among Blacks.

Whites had higher rates than Blacks for most discretionary surgeries while nondiscretionary surgeries (gastrectomy and limb amputation) were elevated among Blacks. The discretionary aspect of common vascular, orthopedic, and laryngologic procedures suggest that lower rates in Blacks are associated with lower rates of referral and access. The total medical admission rate was 22% higher for Blacks.

In the discussion, the authors note that “access, referral practices, and case selection may explain the two to three time higher incidence of vascular surgery among Whites…. Varying rates between communities reflect the interplay of diverse factors, including patient behaviors, morbidity, access, physician practice styles, referral, and resource availability.”