Racial and ethnic disparities in the use of cardiovascular procedures: associations with type of health insurance.

Carlisle, D; Leake, Barbara; Shapiro, Martin F.

doi:10.2105/ajph.87.2.263

Cited by 133 publications

(77 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Differences in access to healthcare may have been a contributor 16 ; however, all women enrolled in HERS had primary care physicians and received regular care for their heart disease. Differences in mental health may have been a factor, but the differences in outcomes persisted despite adjustment for depression.…”

Section: Discussionmentioning

confidence: 99%

Differences in medical care and disease outcomes among black and white women with heart disease

Jha¹,

Varosy²,

Kanaya³

2004

ACC Current Journal Review

View full text Add to dashboard Cite

Background-The risk of cardiovascular mortality is higher among black women than white women, and the reasons for this disparity are largely unexplored. We sought to evaluate differences in medical care and clinical outcomes among black and white women with established coronary artery disease. Methods and Results-Among the 2699 women enrolled in the Heart and Estrogen/progestin Replacement Study (HERS), we used Cox proportional hazards models to determine the association of race with risk of coronary heart disease (CHD) events independent of major cardiovascular risk factors or medical therapies. During an average of 4.1 years of follow-up, CHD events were twice as likely in black compared with white women (6.4 versus 3.1 per 100 person-years, hazard ratio, 2.1; 95% confidence interval, 1.5 to 2.8; PϽ0.001). Black women had higher rates of hypertension, diabetes, and hypercholesterolemia, yet were less likely to receive aspirin or statins. Black women less often had optimal blood pressure (56% versus 63%; Pϭ0.01) and LDL cholesterol (30% versus 38%; Pϭ0.04) control at baseline and during follow-up. After adjusting for these and other differences, black women still had Ͼ50% higher CHD event risk (hazard ratio, 1.52; 95% confidence interval, 1.1 to 2.1; Pϭ0.03). Conclusions-In a large cohort of women with heart disease, black women less often received appropriate preventive therapy and adequate risk factor control despite a greater CHD event risk. Interventions to improve appropriate therapy and risk factor control in all women, and especially black women, are needed.

show abstract

Section: Discussionmentioning

confidence: 99%

Differences in medical care and disease outcomes among black and white women with heart disease

Jha¹,

Varosy²,

Kanaya³

2004

ACC Current Journal Review

View full text Add to dashboard Cite

show abstract

“…17 However, no effect of race or ethnicity was found among patients with private insurance. This study was fundamentally different from ours in that it was not restricted to patients with acute myocardial infarction, there was no adjustment for measures of SES, and there were no quantitative comparisons across insurance groups.…”

Section: Influence Of Insurance Race Sex and Ses On Cardiac Procedmentioning

confidence: 95%

“…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.…”

mentioning

confidence: 99%

“…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. 17,[25][26][27][28] In addition, Medicaid patients with cardiovascular diseases receive their care in hospitals with prevailing characteristics different from those of hospitals in other insurance groups. [11][12][13]17,[26][27][28] Thus, lower rates of procedure use among Medicaid patients may be indicative of more global treatment practices or preferences determined by age, race, sex, SES, or hospital-to-hospital variation.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Underuse of invasive procedures among Medicaid patients with acute myocardial infarction

Philbin

McCullough²,

DiSalvo³

et al. 2001

Am J Public Health

View full text Add to dashboard Cite

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.

show abstract

“…10 Several hypotheses have been put forward to explain differences between US-born blacks and whites, including different patterns of risk factors. 11,12 In addition, it has been noted that blacks have lower rates than whites of utilization of high-technology cardiology services including coronary angiography, angioplasty, and revascularization, [13][14][15][16] as well as other cardiovascular treatments. [17][18][19] It has also been suggested that fatal cardiovascular disease in blacks involves less atherosclerosis of the epicardial coronary arteries than among whites.…”

mentioning

confidence: 99%

Hypertensive Vascular Disease as a Cause of Death in Blacks Versus Whites

Onwuanyi

Hodges²,

Avancha³

et al. 1998

Hypertension

View full text Add to dashboard Cite

Abstract-Cardiovascular disease is the major cause of excess mortality among urban US blacks, but autopsy data comparing black-white differences in underlying pathological causes of cardiovascular death are lacking. We reviewed all 720 adult cases autopsied in 1991 in the New York City Medical Examiner's Office in which the coded cause of death was cardiovascular disease (International Classification of Diseases, 9th Revision, codes 391, 393 to 398, 401 to 404, 410, 411, 414 to 417, 420 to 438, and 440 to 444). After exclusion of 133 cases because race was missing or coded as other than black or white, gender was not coded, or there was an unusual circumstances of death or extreme obesity, 587 cases were available for analysis. There were 314 black and 273 white subjects. Black women were younger than white women at time of death (mean age, 54.7 versus 61.5 years; PϽ.001), whereas black and white men did not differ in mean age at death. Hypertensive vascular disease was the autopsy cause of death in 42% of blacks compared with 23% of whites (PϽ.001). Conversely, atherosclerotic heart disease was the autopsy cause of death in 64% of white subjects but only 38% of blacks. These patterns were consistent in both sexes and after adjustment for age. Hypertensive vascular disease was far more common than atherosclerotic heart disease as the cause of death at autopsy among blacks compared with whites in New York City, whereas atherosclerotic heart disease was more common in whites. These findings suggest that ineffective control of hypertension is a major factor contributing to excess cardiovascular mortality among urban blacks. (Hypertension. 1998;31:1070-1076.)

show abstract

Racial and ethnic disparities in the use of cardiovascular procedures: associations with type of health insurance.

Cited by 133 publications

References 37 publications

Differences in medical care and disease outcomes among black and white women with heart disease

Differences in medical care and disease outcomes among black and white women with heart disease

Underuse of invasive procedures among Medicaid patients with acute myocardial infarction

Hypertensive Vascular Disease as a Cause of Death in Blacks Versus Whites

Contact Info

Product

Resources

About