Author + information
- Received May 9, 1997
- Revision received August 7, 1997
- Accepted August 21, 1997
- Published online December 1, 1997.
- Jeffrey A Ferguson, MD, MPHAB,* (, )
- William M Tierney, MDABC,
- Glenda R Westmoreland, MD, MPHBC,
- Lorrie A Mamlin, MPHAB,
- Douglas S Segar, MD, FACCB,
- George J Eckert, MASB,
- Xiao-Hua Zhou, PhDB,
- Douglas K Martin, MDAB and
- Morris Weinberger, PhDABC
- ↵*Dr. Jeffrey A. Ferguson, Richard L. Roudebush Veterans Affairs Medical Center, Health Services Research and Development (11H), 1481 West 10th Street, Indianapolis, Indiana 46202.
Objectives. We sought to identify the clinical characteristics associated with, and to investigate the impact of cohort selection criteria on, interracial use of invasive cardiac procedures and to determine survival.
Background. Although interracial differences in the use of invasive cardiac procedures have been previously reported, the underlying reasons are not known.
Methods. A retrospective cohort study was conducted at a Veterans Affairs Medical Center. Study patients were evaluated for cardiovascular disease between January 1 and December 31, 1993.
Results. The study included 1,406 male patients (85% white, 58% married), with a mean age of 63.4 years. African Americans were less likely than whites to undergo procedures (cardiac catheterization: odds ratio [OR] 0.37, 95% confidence interval [CI] 0.24 to 0.58; coronary angioplasty: OR 0.60, 95% CI 0.25 to 1.49; coronary bypass surgery: OR 0.22, 95% CI 0.08 to 0.63; any procedure: OR 0.32, 95% CI 0.21 to 0.50). On bivariate analysis, patients who underwent cardiac procedures were more likely to be younger, married and reside nonlocally and less likely to have severe comorbid disease; however, African Americans were less likely to be married and to reside nonlocally and more likely to have severe comorbid disease. Cohorts adjusting for referral status and specified cardiac diagnoses reduced or reversed interracial treatment differences. Thirty-day and 1-year survival rates (96% and 87.6%, respectively) were equivalent.
Conclusions. Racial disparity in invasive cardiac procedure use may be partially explained by clinical differences and cohort selection bias. Despite treatment differences, survival rates were equivalent in African Americans and whites.
☆ This study was funded by Grant SDR 94-009 from the Health Services Research and Development Service, Roudebush Department of Veterans Affairs, Indianapolis, Indiana and was presented in part at the 19th Annual Meeting of the Society of General Internal Medicine, Washington, D.C., May 1996.
- Received May 9, 1997.
- Revision received August 7, 1997.
- Accepted August 21, 1997.
- The American College of Cardiology