This prospective study analyzed data from the National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Follow-up Study, a longitudinal study of participants in the nationwide survey from 1971 to 1975 of the non-institutionalized population of the United States. For a cohort with no history of coronary heart disease (CHD) at baseline, the study sought to determine if the incidence of coronary procedures during or after hospitalization differed between blacks and whites.

The investigators found that the “incidence of coronary artery bypass grafting or angioplasty was 27.8 (n= 245) per 1000 person-years in white persons but only 5.1 (n = 6) per 1000 person-years in African-American persons (ratio 5.5). The incidence of cardiac catheterization or coronary angioplasty was 40.3 (n = 355) per 1000 person-years in white persons and 25.6 (n = 30) per 1000 person-years in African-American persons (ratio 1.6). For any of these procedures, the rates were 47.0 (n= 414) per 1000 person-years in white persons and 26.5 (n=31) per 1000 person-years in African-American persons (ratio, 1.8).”

In sum, African-Americans were 60% less likely to undergo any of these procedures any date after first hospitalization for CHD. The RR for any type of revascularization was 0.15 (CI, 0.02 to 1.05) and, for angiography or catheterization, the RR was 0.53 (CI, 0.21 to 1.34). Adjustment for multiple risk factors did not affect these results. These findings are coupled with the conclusion that, in comparison to white persons, the age-adjusted risk for coronary heart disease is 1.76 times higher in black women, with an age-adjusted mortality rate that is 2.25 times higher.

“On the basis of these findings,” the authors recommend that “physicians must take extra care to promote the appropriate use of cardiac catheterization and coronary revascularization among African American patients, given the repeatedly observed disparities in utilization of these procedures.”