J Gen Intern Med 2001 Apr;16(4):227-34
Do race and gender influence the use of invasive procedures?
Watson RE, Stein AD, Dwamena FC, Kroll J, Mitra R, McIntosh BA, Vasilenko
P 3rd, Holmes-Rovner MM, Chen Q, Kupersmith J; Michigan State University
Inter-Institutional Collaborative Heart Study Group.
College of Human Medicine, Michigan State University, East Lansing, MI
48824-1315, USA.
OBJECTIVE: To assess the influence of race and gender
influence on the use of invasive procedures in patients with acute myocardial
infarction (AMI) in community hospitals.
DESIGN: Prospective, observational.
SETTING: Five mid-Michigan community hospitals.
PATIENTS: All patients (838) identified with AMI between
January 1994 and April 1995 in 1 of these hospitals.
MEASUREMENTS AND MAIN RESULTS: After adjusting for age,
hospital of admission, insurance type, severity of AMI, and comorbidity,
using white men as the reference group, the rate of being offered cardiac
catheterization (CC) was 0.88 (95% confidence interval [95% CI], 0.60
to 1.29) for white women; 0.79 (95% CI, 0.41 to 1.50) for black men; and
1.14 (95% CI, 0.53 to 2.45)for black women. Among patients who underwent
CC, after also adjusting for coronary artery anatomy, the rate of being
offered angioplasty, using white men as the reference group, was 1.22
(95% CI, 0.75 to 1.98) for white women; 0.61 (5% CI, 0.29 to 1.28, P =.192)
for black men; and 0.40 (95% CI, 0.14 to 1.13) for black women The adjusted
rate of being offered bypass surgery was 0.47 (95% CI, 0.24 to 0.89) for
white women; 0.36 (95% CI, 0.12 to 1.06) for black men; and 0.37 (95%
CI, 0.11 to 1.28)for black women.
CONCLUSIONS: Our study shows that white women are less
likely than white men to be offered bypass surgery after AMI. Although
black men and women with AMI are less likely than white men to be offered
percutaneous transluminal coronary angioplasty or coronary artery bypass
grafting in both unadjusted and adjusted analyses, these findings did
not reach statistical significance. Our study is limited in power due
to the small number of blacks in the sample.
PMID: 11318923 [PubMed - indexed for MEDLINE]
