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Ann Intern Med. 1999 Feb 2;130(3):173-82.

Use of cardiovascular procedures among black persons and white persons: a 7-year nationwide study in patients with renal disease.

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1
Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Abstract

BACKGROUND:

Black persons historically undergo fewer invasive cardiovascular procedures than white persons.

OBJECTIVE:

To determine whether acquisition of Medicare health insurance and comprehensive care for severe illness reduce ethnic disparity in use of cardiovascular procedures.

DESIGN:

7-year longitudinal analyses in a cohort from the United States Renal Data System.

SETTING:

Health care institutions in the United States.

PATIENTS:

Nationwide random sample of 4987 adult black and white patients with incident end-stage renal disease (ESRD) from 303 dialysis facilities in 1986 to 1987.

MEASUREMENTS:

Medical history and service use records, physical examination, and laboratory data. Main outcome measures were receipt of a coronary catheterization or revascularization procedure before (baseline) and after (follow-up) development of ESRD and acquisition of Medicare, adjusted for clinical and socioeconomic variables.

RESULTS:

At baseline, 9.9% of white patients and 2.8% of black patients had had a cardiac procedure; the odds were almost three times greater in white than in black patients (adjusted odds ratio, 2.92 [95% CI, 2.04 to 4.18]). During follow-up, white patients were only 1.4 times more likely than black patients to have a procedure (adjusted relative risk, 1.41 [CI, 1.13 to 1.77]); rates were 7.8% for white persons and 8.5% for black persons. In patients with Medicare coverage before development of ESRD, the initial three-fold difference in procedure use was eliminated over follow-up (odds ratio, 1.05 [CI, 0.56 to 1.60]). For procedures after hospital admission for myocardial infarction or coronary disease, no difference between ethnic groups was seen during follow-up (relative risk, 1.12 [CI, 0.68 to 1.85]).

CONCLUSIONS:

Differences between ethnic groups in use of cardiovascular procedures narrowed markedly once a serious illness (ESRD) developed and adequate insurance coverage was ensured; the disparity was eliminated in patients with previous Medicare insurance or a stronger indication for a procedure. These findings suggest that almost equal access to care is attainable by combining insurance with delivery of comprehensive, clinically appropriate care.

PMID:
10049195
[Indexed for MEDLINE]
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