Arch
Intern Med 2000 May 8;160(9):1329-35
Understanding racial variation in the use of coronary revascularization
procedures: the role of clinical factors.
Conigliaro J, Whittle J, Good CB, Hanusa BH, Passman LJ, Lofgren RP, Allman
R, Ubel PA, O'Connor M, Macpherson DS.
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
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.
Publication Types: Multicenter Study
PMID: 10809037 [PubMed - indexed for MEDLINE]
