The purpose of this article is to report patterns of utilization of coronary artery bypass surgery and coronary angiography by year, age, sex, race and region, as well as patterns of coronary mortality and morbidity indicators. The data were derived from the National Hospital Discharge Survey for 1979 to 1983. The authors note that, "because of the much larger percent of cases with missing race (13%) than for the other imputed variables, caution should be used in drawing conclusions from the data by race." However, this editorial illustrates the types of explanations that were being considered by researchers in the early 1980's for potential racial differences in treatment.

The author makes several comparisons by race, noting in each that blacks were less likely to receive invasive treatments. For example, the Standardized Morbidity Ratio for receipt of coronary bypass surgery for blacks (ratio of observed rate to expected rate had blacks received the same care as whites) was 0.28; the SMR for coronary angiography was 0.49. Other analyses using various surgical control groups confirmed this racial pattern for coronary procedures. It is further noted that the lower utilization rates in blacks compared with whites are inconsistent with racial patterns reported in recent mortality, incidence, and prevalence data.

The author states, "One may hypothesize that black patients presenting with chest pain were less likely to be investigated for obstructive coronary artery disease and/or to be referred for revascularization if operable multivessel disease was found." As a possible explanations for this pattern, he suggests the possibilities that clinicians believed that angina pectoris due to obstructive coronary artery disease was uncommon in blacks (as was taught for many decades); black patients were not referred for expensive procedures because of their financial constraints; black patients refused surgery more frequently; and black patients were less likely to be operable than white patients.

Other possible explanations for the disparities are addressed in the author’s discussion of directions for future research on racial disparities in coronary care. The importance of evaluating the physician decision-making processes is noted. "Clinical decision making could be examined in physicians caring for black and white patients presenting with chest pain in a large prepaid HMO, or in reviews of data collected for longitudinal studies or clinical trials." Furthermore, "a survey could be done of physicians' beliefs regarding the probability of obstructive coronary artery disease and preferences for therapy in black compared with white patients." Other suggestions for future research include further examination of the influence of socioeconomic status and of racial differences in efficacy of these treatments.