Mitchell JB, Khandker RK.
Black-white treatment differences in acute myocardial infarction.
Health Care Financ Review 1995;17(2):61-70.

Medicare claims data were evaluated for cardiac procedures conducted during the 90-day period after patients’ first admissions for acute myocardial infarction (AMI). The patient group included an oversampling of beneficiaries considered to be vulnerable to access barriers, including blacks, the disabled, and residents of areas with physician shortage or poverty.

Black and white patients differed significantly with regard to a number of patient characteristics in several relevant ways, including age (blacks were younger), comorbidity (for most diseases, blacks had higher comorbidity), socioeconomic status (SES) measures (blacks were more likely to be dually eligible for Medicare/Medicaid and to live in poverty areas, physician shortage areas, and rural areas), and hospital type (blacks were more likely to be admitted to large and teaching hospitals). There were no race differences in 90-day mortality rates. After controlling for all of these factors, blacks still had significantly lower odds of cardiac catheterization and revascularization.

It is important to note that, while the authors do not explain the race differences in use of cardiac procedures, the measures used in this study related to ability to pay (specifically, patients dually eligible for Medicare/Medicaid and patients living in poverty areas) were associated with use of services, indicating that limited resources affected the probability of receiving services.

The authors conclude that both financial and non-financial barriers to care may exist, particularly for the subset of patients who are dually eligible. ‘More research, especially with regard to the role of patient decision-making, is needed to determine the reasons behind these differences in treatment.”