Continuing differences in the rates of percutaneous transluminal coronary angioplasty and coronary artery bypass graft surgery between elderly black and white Medicare beneficiaries

McBean, A. Marshall; Warren, Joan L.; Babish, J. Daniel

doi:10.1016/0002-8703(94)90115-5

Cited by 66 publications

(27 citation statements)

References 15 publications

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“…The overwhelming majority of studies show that women and blacks receive fewer invasive diagnostic procedures and therapeutic interventions for coronary artery disease than white men on a population basis [3][4][5][6][7] and after a coronary event. 4,8 -21 Although some of these decisions might be clinically appropriate given differences in presentation, particularly between men and women, some studies show that even given similar presentation, blacks and women are less likely to receive PCI and especially CABG than are white men.…”

mentioning

confidence: 99%

Temporal Trends in the Utilization of Diagnostic Testing and Treatments for Cardiovascular Disease in the United States, 1993–2001

et al. 2006

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Background-Rates of invasive testing and treatment for coronary artery disease have increased over time. Less is known about trends in the utilization of noninvasive cardiac testing for coronary artery disease. The objective of this study was 2-fold: to explore temporal trends in the utilization of noninvasive and invasive cardiac services in relation to changes in the prevalence of cardiac disease, and to examine whether temporal increases have been targeted to potentially underserved populations. Methods and Results-We performed an annual cross-sectional population-based study of Medicare patients from 1993 to 2001. We identified stress testing, cardiac catheterization, and revascularization procedures, as well as hospitalizations for acute myocardial infarction, during each year and calculated population-based rates for each using the total fee-for-service Medicare population as the denominator and adjusting for age, gender, and race. We observed marked growth in the utilization rates of cardiac services over time, with relative rates nearly doubling for most services. Acute myocardial infarction hospitalization rates have remained stable over the study period. Although rates of all procedures except coronary artery bypass increased in all subgroups, differences in rates of cardiac testing and treatment between nonblack men and other subgroups persisted over time. Conclusions-Temporal increases in the use of noninvasive and invasive cardiac services are not explained by changes in disease prevalence and have not succeeded in narrowing preexisting treatment differences by gender and race. Such increases, although conferring benefit for some, may expose others to risk and cost without benefit. (Circulation. 2006; 113:374-379.)

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confidence: 99%

Temporal Trends in the Utilization of Diagnostic Testing and Treatments for Cardiovascular Disease in the United States, 1993–2001

et al. 2006

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“…In aggregate, these reports provide compelling evidence for prevalent physician or patient biases in the management of stable coronary artery disease and acute coronary syndromes. 5,8,10,12,13,[17][18][19][20][21][22][23][24][25][26] Likewise, patients with Medicaid insurance who are treated for acute myocardial infarction are less likely to undergo invasive procedures than those with other forms of insurance, suggesting that they receive a different, and perhaps inferior, process of care. 26 However, the Medicaid population differs from other insurance groups in terms of age, race, and sex mix; socioeconomic status (SES); and prevalence of coexistent illnesses.…”

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confidence: 99%

Underuse of invasive procedures among Medicaid patients with acute myocardial infarction

Philbin

McCullough²,

DiSalvo³

et al. 2001

Am J Public Health

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OBJECTIVES: The purpose of this study was to determine whether underuse of cardiac procedures among Medicaid patients with acute myocardial infarction is explained by or is independent of fundamental differences in age, race, or sex distribution; income, coexistent illness; or location of care. METHODS: Administrative data from 226 hospitals in New York were examined for 11,579 individuals hospitalized with a primary diagnosis of acute myocardial infarction. Use of various cardiac procedures was compared among Medicaid patients and patients with other forms of insurance. RESULTS: Medicaid patients were older, were more frequently African American and female, and had lower median household incomes. They also had a higher prevalence of hypertension, diabetes, lung disease, renal disease, and peripheral vascular disease. After adjustment for these and other factors, Medicaid patients were less likely to undergo cardiac catheterization, percutaneous transluminal coronary angioplasty, and any revascularization procedure. CONCLUSIONS: Factors other than age, race, sex, income, coexistent illness, and location of care account for lower use of invasive procedures among Medicaid patients. The influence of Medicaid insurance on medical practice and process of care deserves investigation.

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“…suggested that racial and ethnic differences in the use of cardiac procedures narrowed during the late 1980s and 1990s, 18,28,32 our results show that important differences remain. Thus, specific interventions are needed to accelerate the narrowing of this gap.…”

Section: Discussionmentioning

confidence: 56%

“…Other analyses of Medicare data sets also have found that African Americans were less likely to receive various invasive cardiac procedures than were Whites. [10][11][12][13][14]18,19,25 However, the clinical data available in the CCP were not available to earlier investigators of Medicare data. Use of the CCP data allowed us to better adjust for differences in disease severity and other clinical factors that may have affected the frequency of procedures among the various racial or ethnic groups.…”

Section: Discussionmentioning

confidence: 99%

Racial and ethnic differences in the use of cardiovascular procedures: findings from the California Cooperative Cardiovascular Project

Ford

Newman²,

Deosaransingh³

2000

Am J Public Health

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Methods. The use of catheterization, percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass graft (CABG) surgery, and several noninvasive tests among all patients 65 years or older with a confirmed acute myocardial infarction in nonfederal hospitals from 1994 to 1995 was studied.Results. African Americans (n = 527) were less likely than Whites Conclusions. African Americans were less likely than Whites to undergo costly invasive cardiovascular procedures. In addition, Hispanics were less likely than Whites to have received catheterization and PTCA. (Am J Pub-

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Continuing differences in the rates of percutaneous transluminal coronary angioplasty and coronary artery bypass graft surgery between elderly black and white Medicare beneficiaries

Cited by 66 publications

References 15 publications

Temporal Trends in the Utilization of Diagnostic Testing and Treatments for Cardiovascular Disease in the United States, 1993–2001

Temporal Trends in the Utilization of Diagnostic Testing and Treatments for Cardiovascular Disease in the United States, 1993–2001

Underuse of invasive procedures among Medicaid patients with acute myocardial infarction

Racial and ethnic differences in the use of cardiovascular procedures: findings from the California Cooperative Cardiovascular Project

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