Race/Ethnic Disparities in Utilization of Lifesaving Technologies by Medicare Ischemic Heart Disease Beneficiaries

Cromwell, Jerry; McCall, Nancy; Burton, Joseph; Urato, Carol

doi:10.1097/01.mlr.0000156864.80880.aa

Cited by 35 publications

(26 citation statements)

References 26 publications

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“…1212 Moreover, African Americans and Hispanics are 10% to 40% less likely to receive outpatient secondary prevention therapies for cardiovascular disease. 1213 Although lower rates of diagnostic and interventional services have not been adequately explained, 1214,1215 it is clear that individuals of lower socioeconomic status and ethnic minorities typically have fewer healthcare resources, have worse general health and cardiac risk profiles, and are less knowledgeable about SIHD symptoms. Healthcare providers and systems should strive to eliminate or ameliorate barriers to care for patients who have SIHD and are of low socioeconomic class or ethnic minorities.…”

Section: Socioeconomic Factorsmentioning

confidence: 99%

2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease

Fihn¹,

Gardin²,

Abrams³

et al. 2012

Circulation

736

441

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Section: Socioeconomic Factorsmentioning

confidence: 99%

2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease

Fihn¹,

Gardin²,

Abrams³

et al. 2012

Circulation

736

441

View full text Add to dashboard Cite

“…8 Black and American Indian patients were much less likely to undergo revascularization procedures, and these groups, as well as Hispanic and Asian patients, derived substantially lower survival benefits on average than white patients, raising provocative questions about why these differences arise despite Medicare insurance coverage and comparable access to hospitals performing these procedures. Similarly, a recent study we conducted found that insurance coverage was associated with substantial reductions in mortality for near-elderly white adults but not for a comparable cohort of black adults.…”

mentioning

confidence: 98%

Integrating Research on Racial and Ethnic Disparities in Health Care Over Place and Time

Zaslavsky¹,

Ayanian²

2005

Medical Care

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B lack Americans have substantially higher rates of cardiovascular mortality than other racial and ethnic groups in the United States, and they have experienced much less improvement in this important outcome than white Americans over the past 15 years. 1,2 Racial disparities in cardiovascular treatment contributing to this mortality gap have been extensively documented. [3][4][5] Numerous deficiencies, however, limit the usefulness of prior studies of racial and ethnic disparities in health care to guide policy and improve clinical practice and outcomes. Even studies with national scope have rarely assessed the extent to which variations among regions, local health markets, or hospitals might mediate observed racial disparities in care. Cross-sectional studies provide little information on changes over time. Furthermore, many studies have focused solely on black and white patients, providing little understanding of treatments and outcomes for other major racial and ethnic groups, including Latinos, Asian Americans, Pacific Islanders, and American Indians.Three new studies in this issue of Medical Care consider racial and ethnic differences in cardiovascular care across providers, 6 over time, 7 and across multiple groups. 8 Each study contributes to our understanding of specific aspects of disparities in care.Using data from the Cooperative Cardiovascular Project (CCP) for nearly 140,000 elderly Medicare beneficiaries treated in the mid-1990s at approximately 4700 hospitals, Barnato and colleagues analyzed the relative contributions of within-hospital and between-hospital effects to disparities between black and white patients in medical therapies, coronary procedures, and risk-adjusted mortality after myocardial infarction. 6 They concluded that black patients more often were treated in hospitals where effective medical therapies were less often prescribed, coronary procedures were more often used, and 30-day mortality rates were worse; thus, hospital assignment was an important mediator of disparities. These findings complement another recent study by Rathore et al from the CCP that attributed similar racial differences to regional variations in care, 9,10 with black patients disproportionately treated in the Southeast where beta blockers are less often prescribed, coronary angioplasty is more common, and risk-adjusted mortality rates are higher than in the Northeast. 11,12 These 2 studies both may be correct in attributing a part of racial disparities to variations in quality across hospitals or regions, respectively, but because each study assessed only 1 of these factors, the relative importance of hospital and regional effects cannot be determined. Furthermore, only very limited data were available From the

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“…2 The study examines residential and hospital racial segregation and evaluates their relationship to the use of high-mortality hospitals, after accounting for the influence of income and geographic proximity.…”

mentioning

confidence: 99%

Racial Differences In Hospital Use After Acute Myocardial Infarction: Does Residential Segregation Play A Role?

2009

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This study compares the likelihood of admission to high-mortality hospitals for black and white Medicare patients in 118 health care markets, and whether admission patterns vary if residential racial segregation is greater in the area. Risk of admission to high-mortality hospitals was 35 percent higher for blacks than for whites in markets with high residential segregation. Moreover, blacks were more likely than whites to be admitted to hospitals with high mortality, even in analyses limited to patients who lived closest to lower-mortality hospitals. Eliminating health care disparities may require policies that address social factors leading to segregation.

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Race/Ethnic Disparities in Utilization of Lifesaving Technologies by Medicare Ischemic Heart Disease Beneficiaries

Cited by 35 publications

References 26 publications

2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease

2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease

Integrating Research on Racial and Ethnic Disparities in Health Care Over Place and Time

Racial Differences In Hospital Use After Acute Myocardial Infarction: Does Residential Segregation Play A Role?

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