This study was one of first to examine racial differences in cardiovascular care at the national level. The results from the analysis of data from the National Hospital Discharge Survey suggest that, from 1979 and 1984, blacks with discharge diagnoses of acute myocardial infarction in the United States received significantly less tertiary care for coronary artery disease (CAD) as measured by coronary arteriography and coronary artery bypass graft (CABG) surgery.

The rate of myocardial infarction for black men was 77% that of white men, yet blacks were half as likely to undergo arteriography and a third as likely to have CABG performed. Black women had even higher rates of AMI compared to white women but had a 19% lower rate of arteriography and were half as likely to undergo CABG surgery. As a means of estimating health care utilization relative to need, ratios of the rates of each procedure to rates of AMI were calculated. The investigators found that one arteriogram was performed per every 2.5 white men and 2.5 white women discharged with AMI versus every 3.6 black men and 3.2 black women. A CABG surgery was recorded for every 2.8 white men versus every 6.2 black men discharged with AMI diagnosis. Investigators controlled for principal source of payment and hospital type. Due to large standard errors, no definitive conclusion was made with regard to the relationship between type of hospital and procedure performed. On the other hand, the results of the analysis on primary source of payment suggested that reimbursement for procedural care for Black patients was more likely to originate from Medicaid and other government programs.

Overall, the results of the study suggest “that these differentials reflect a biased institutional response since the burden of CAD reported in the same survey does not justify lower rates of cardiac procedures in Blacks.”