This study sought to assess the effect of race and ethnicity in the use of eight health care procedures – including coronary artery angioplasty (PTCA), coronary artery bypass grafting (CABG), carotid endarterectomy – in South Central Los Angeles (SCLA) compared with the remainder of Los Angeles County. SCLA is a historically black (and increasingly Latino) urban neighborhood with high levels of poverty, unemployment, violence, and crime. The use of the surgical procedures was assessed over a three-year period from January 1986 to December 1988 through analysis of the California Hospital Discharge Data Set. The American Medical Association’s Physician Profile Database was utilized to obtain the total number of physicians and procedure-specific specialists practicing in each zip code for the calendar year 1987. Note that information on health insurance prevalence and type was not collected.

The investigators found that hospital resources were less available in the South Central region compared with the rest of Los Angeles. For instance, SCLA had a ratio of 1 bed per 1,966 people in comparison to 1 bed per 282 people in all of Los Angeles. The use of four procedures was significantly lower in SCLA: (1) 9.3 PCTA surgeries per 10,000 SCLA residents compared to 14.8 per 10,000 for other Los Angeles residents; (2) 11.0 CABG surgeries versus 18.2; (3) 3.2 carotid endarterectomy procedures versus 6.9; and (4) 212 cesarean section per 1,000 deliveries compared to 274. When ethnicity variables (percentage of zip code residents who were African-American and Latino) were incorporated into the multivariate models, the SCLA regional effect was significant for only CABG, C-section, and (negatively) for hysterectomy. The findings indicate that “residents of South Central Los Angeles still have fewer physicians (there are 4.7 times as many physicians per resident in all of Los Angeles County as there are in South Central Los Angeles,” as well as fewer hospital beds. SCLA residents “may have poorer health status, and often use [or in any case receive] fewer procedures than the Los Angeles County population as a whole.”

In considering their findings, the authors state, “Given evidence currently in the medical literature, it is likely that ethnicity is an intermediary for an array of factors influencing procedure use. These include factors that affect ability to obtain medical care (insurance status, language), the willingness to seek medical care (underlying health beliefs, education), and the quality of care received (physician practice style and attitudes toward patients with certain characteristics).” They note that the “finding is particularly worrisome as it points out a persistent disparity in geographic equity of health care services unrelated to any factors that have been demonstrated to be relevant to this issue in previous research.”