The authors acknowledge the consistent finding that African-Americans receive fewer high-technology cardiac services than whites and note the dichotomous current explanations for this disparity: either Black patients “prefer” fewer services than white patients or physicians’ treatment decisions are influenced–either consciously or unconsciously–by patient race. In this study, they examine a prior question in “the complex chain of events that precedes” the point of decision-making. Specifically, “do Black patients receive fewer high-technology cardiac services...than their White counterparts because of diminished access to hospitals offering those services?”

To explore this question, the authors used the New York State SPARCS system, a hospital discharge abstract set that covers all hospitals in the state, to examine the records of some 11,410 patients with a principal diagnosis of acute myocardial infarction, “a population of individuals with an unequivocal, objective need for hospitalization,” discharged in a four-month period of 1986. To study the impact of race per se, they controlled for sex, age, income, insurance carrier and disease severity; however, they also examined home-to-hospital distance, since geographic proximity is a key determinant of service utilization and institutional choice. Hospitals were classified as either “low-tech” (offering neither cardiac catheterization, coronary angioplasty or bypass surgery) or “high-tech” (offering at least one of those services).

Blacks and whites presented equally to high-tech hospitals (about a third of each group), but when an adjustment for home to hospital distance was introduced into the multivariate model, whites were 68% likelier to do so. Both groups tended to present to nearby hospitals, and high-tech hospitals tend to be located in urban areas, where blacks are likelier to live. However, when the nearest hospital was low-tech, whites – with presumably greater resources for travel – were much likelier to bypass it and go to a high-tech institution.