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January 13, 1989, Vol 261, No. 2 >
ARTICLE | January 13, 1989

Racial Inequalities in the Use of Procedures for Patients With Ischemic Heart Disease in Massachusetts FREE

Mark B. Wenneker, MD; Arnold M. Epstein, MD, MA
[+] Author Affiliations

Reprint requests to Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115 (Dr Epstein).


JAMA. 1989;261(2):253-257. doi:10.1001/jama.1989.03420020107039
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References

To examine interracial differences in the utilization of coronary angiography, coronary artery bypass grafting, and coronary angioplasty for white and black patients, we examined all admissions for circulatory diseases or chest pain to Massachusetts hospitals in 1985. After controlling for age, sex, payer, income, primary diagnoses, and the number of secondary diagnoses, whites underwent significantly more angiography and coronary artery bypass grafting procedures. Whites also underwent more angioplasty procedures, but the difference was not statistically significant. Although utilization differences may reflect patient preference or different levels of disease severity and socioeconomic status not adequately accounted for, this study suggests that substantial racial inequalities exist in the use of procedures for patients hospitalized with coronary heart disease.

(JAMA 1989;261:253-257)

REFERENCES

1 +
Stern RS, Epstein AM:  Institutional responses to prospective payment based on diagnoses related groups . N Engl J Med 1985;;312:621-627.
2 +
Aday LA, Anderson RM:  The national profile of access to medical care: Where do we stand? Am J Public Health 1984;;74:1331-1339.
3 +
Davis K, Gold M, Makuc D:  Access to health care for the poor: Does the gap remain? Annu Rev Public Health 1981;;2:159-182.
4 +
Diehr P, Martin DP, Price KF, et al:  Use of ambulatory care services in three provider plans . Am J Public Health 1984;;74:47-51.
5 +
James SA, Wagner EH, Strogatz DS, et al:  The Edgecombe County (NC) High Blood Pressure Control Program . Am J Public Health 1984;;74:468-472.
6 +
Yergan J, Flood AB, LoGerfo JP, et al:  Relationship between patient race and the intensity of hospital services . Med Care 1987;;25:592-603.
7 +
Wilson PA, Griffith JR, Tedeschi PJ:  Does race affect hospital use? Am J Public Health 1985;;75: 263-269.
8 +
Bombardier C, Fuchs VR, Lillard LE, et al:  Socioeconomic factors affecting the utilization of surgical operations . N Engl J Med 1977;;297:699-705.
9 +
Gillum RF:  Coronary artery bypass surgery and coronary angiography in the United States, 1979-1983 . Am Heart J 1987;;113:1255-1260.
10 +
Ford E, Cooper R, Castaner A, et al:  Coronary arteriography and coronary bypass surgery among whites and non-whites relative to hospital-based incidence rates for coronary artery disease . Am J Public Health , in press.
11 +
Oberman A, Cutter G:  Issues in the natural history and treatment of coronary heart disease in black populations: Surgical treatment . Am Heart J 1984;;108:688-694.
12 +
CASS (Principal Investigators and Associates):  Myocardial infarction and mortality in the Coronary Artery Surgery Study (CASS): Randomized trial . N Engl J Med 1984;;310:750-758.
13 +
European Coronary Surgery Study Group:  Long-term results of prospective randomized study of coronary artery bypass surgery in stable angina pectoris . Lancet 1982;;2:1173-1180.
14 +
Peduzzi P, Hullgren HN:  Effect of medical vs surgical treatment of symptoms in stable angina pectoris: The Veterans Administration Cooperative Study of Surgery for Coronary Arterial Occlusive Disease . Circulation 1979;;60:888-900.
15 +
Detailed Diagnosis and Procedures for Patients Discharged from Short-term Hospitals, US 1985 , US Dept of Health and Human Services publication (PHS) 87-1751. National Center for Health Statistics, 1985;.
16 +
Maynard C, Fisher LD, Passamani ER, et al:  Blacks in the Coronary Artery Surgery Study . Circulation 1986;;74:64-71.
17 +
Colton T: Statistics in Medicine . Boston, Little Brown & Co Inc, 1974;.
18 +
Robins J, Greenland S, Breslow NE:  A general estimator for the variance of the Mantel-Haenszel odds ratio . Am J Epidemiol 1986;;124:719-723.
19 +
SUGI Supplemental Library User's Guide, version 5. Cary, NC, SAS Institute, 1986.
20 +
General Population Characteristics Massachusetts , US Dept of Commerce publication PC80-1-B23. Bureau of the Census, 1982;.
21 +
Cassel J, Heyden S, Bartel AG, et al:  Incidence of coronary heart disease by ethnic group, social class and sex . Arch Intern Med 1971;;128:901-906.
22 +
Gillum RF:  Coronary heart disease in black populations: I. Mortality and morbidity . Am Heart J 1982;;104:839-851.
23 +
Curry CL, Oliver J, Mumtaz FB:  Coronary artery disease in blacks: Risk factors . Am Heart J 1984;:108:653-657.
24 +
Gillum RF, Grant CT:  Coronary heart disease in black populations: II. Risk factors . Am Heart J 1982;;104:852-864.
25 +
Hagstrom RM, Federspiel CF, Ho YC:  Incidence of myocardial infarction and sudden death from coronary heart disease in Nashville, Tennesee . Circulation 1971;;44:884-890.
26 +
Keil JE, Saunders DE, Lackland DT, et al:  Acute myocardial infarction: Period prevalence, case fatality, and comparison of black and white cases in urban and rural areas of South Carolina . Am Heart J 1985;;109:776-784.
27 +
Weisse AB, Abiuso PD, Thind IS:  Acute myocardial infarction in Newark, NJ: A study of racial incidence . Arch Intern Med 1977;;137:1402-1405.
28 +
Sempos C, Cooper R, Kovar MG, et al:  Divergence of the recent trends in coronary mortality for the four major race-sex groups in the United States . Am J Public Health 1988;;78:1422-1427.
29 +
Dutton D:  Explaining the low use of health services by the poor . Am Soc Rev 1978;;43:348-368.
30 +
Hayward RA, Shapiro MF, Freeman HE, et al:  Inequities in health services among insured Americans . N Engl J Med 1988;;318:1507-1512.
31 +
Greenberg ER, Chute CG, Stukel T, et al:  Social and economic factors in the choice of lung cancer treatment . N Engl J Med 1988;;318:612-617.
32 +
Wennberg J, Gittelsohn A:  Small-area variations in health care delivery . Science 1982;;246:120-135.
33 +
Chassin MR, Brook RH, Park RE:  Variations in the use of medical and surgical services by the Medicare population . N Engl J Med 1986;;314:285-290.
34 +
Brook RH, Kosecoff JB, Park RE, et al:  Diagnosis and treatment of coronary disease: Comparison of doctor's attitudes in the USA and UK . Lancet 1988;;1:750-753.
35 +
Eisenberg JM:  Sociologic influences on medical decision making by clinicians . Ann Intern Med 1979;;90:957-964.
36 +
Egbert LD, Rothman IL:  Relation between race and economic status of patients and who performs their surgery . N Engl J Med 1977;;297:90-91.
37 +
Demlo LK, Campbell PM:  Improving hospital discharge data . Med Care 1981;;19:1030-1040.
38 +
Hsia DC, Krushat M, Fagan AB, et al:  Accuracy of diagnostic coding for Medicare patients under the prospective-payment system . N Engl J Med 1988;;318:352-355.
39 +
Iezzoni LI, Burnside S, Sickles L, et al:  Coding of acute myocardial infarction: Clinical and policy implications . Ann Intern Med 1988;;109:745-751.
40 +
Sloan FS, Valvona J, Mullner R:  Identifying the issues: A statistical profile , in Sloan F, Blumenstein J, Perrin J (eds): Uncompensated Hospital Care: Rights and Responsibilities . Baltimore, Johns Hopkins University Press, 1986;, pp 16-53.
41 +
Roos NP, Wennberg JE, McPherson K:  Using diagnosis-related groups for studying variations in hospital admissions . Health Care Financ Rev , (Summer) 1988;, p 53.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Stern RS, Epstein AM:  Institutional responses to prospective payment based on diagnoses related groups . N Engl J Med 1985;;312:621-627.
2 +
Aday LA, Anderson RM:  The national profile of access to medical care: Where do we stand? Am J Public Health 1984;;74:1331-1339.
3 +
Davis K, Gold M, Makuc D:  Access to health care for the poor: Does the gap remain? Annu Rev Public Health 1981;;2:159-182.
4 +
Diehr P, Martin DP, Price KF, et al:  Use of ambulatory care services in three provider plans . Am J Public Health 1984;;74:47-51.
5 +
James SA, Wagner EH, Strogatz DS, et al:  The Edgecombe County (NC) High Blood Pressure Control Program . Am J Public Health 1984;;74:468-472.
6 +
Yergan J, Flood AB, LoGerfo JP, et al:  Relationship between patient race and the intensity of hospital services . Med Care 1987;;25:592-603.
7 +
Wilson PA, Griffith JR, Tedeschi PJ:  Does race affect hospital use? Am J Public Health 1985;;75: 263-269.
8 +
Bombardier C, Fuchs VR, Lillard LE, et al:  Socioeconomic factors affecting the utilization of surgical operations . N Engl J Med 1977;;297:699-705.
9 +
Gillum RF:  Coronary artery bypass surgery and coronary angiography in the United States, 1979-1983 . Am Heart J 1987;;113:1255-1260.
10 +
Ford E, Cooper R, Castaner A, et al:  Coronary arteriography and coronary bypass surgery among whites and non-whites relative to hospital-based incidence rates for coronary artery disease . Am J Public Health , in press.
11 +
Oberman A, Cutter G:  Issues in the natural history and treatment of coronary heart disease in black populations: Surgical treatment . Am Heart J 1984;;108:688-694.
12 +
CASS (Principal Investigators and Associates):  Myocardial infarction and mortality in the Coronary Artery Surgery Study (CASS): Randomized trial . N Engl J Med 1984;;310:750-758.
13 +
European Coronary Surgery Study Group:  Long-term results of prospective randomized study of coronary artery bypass surgery in stable angina pectoris . Lancet 1982;;2:1173-1180.
14 +
Peduzzi P, Hullgren HN:  Effect of medical vs surgical treatment of symptoms in stable angina pectoris: The Veterans Administration Cooperative Study of Surgery for Coronary Arterial Occlusive Disease . Circulation 1979;;60:888-900.
15 +
Detailed Diagnosis and Procedures for Patients Discharged from Short-term Hospitals, US 1985 , US Dept of Health and Human Services publication (PHS) 87-1751. National Center for Health Statistics, 1985;.
16 +
Maynard C, Fisher LD, Passamani ER, et al:  Blacks in the Coronary Artery Surgery Study . Circulation 1986;;74:64-71.
17 +
Colton T: Statistics in Medicine . Boston, Little Brown & Co Inc, 1974;.
18 +
Robins J, Greenland S, Breslow NE:  A general estimator for the variance of the Mantel-Haenszel odds ratio . Am J Epidemiol 1986;;124:719-723.
19 +
SUGI Supplemental Library User's Guide, version 5. Cary, NC, SAS Institute, 1986.
20 +
General Population Characteristics Massachusetts , US Dept of Commerce publication PC80-1-B23. Bureau of the Census, 1982;.
21 +
Cassel J, Heyden S, Bartel AG, et al:  Incidence of coronary heart disease by ethnic group, social class and sex . Arch Intern Med 1971;;128:901-906.
22 +
Gillum RF:  Coronary heart disease in black populations: I. Mortality and morbidity . Am Heart J 1982;;104:839-851.
23 +
Curry CL, Oliver J, Mumtaz FB:  Coronary artery disease in blacks: Risk factors . Am Heart J 1984;:108:653-657.
24 +
Gillum RF, Grant CT:  Coronary heart disease in black populations: II. Risk factors . Am Heart J 1982;;104:852-864.
25 +
Hagstrom RM, Federspiel CF, Ho YC:  Incidence of myocardial infarction and sudden death from coronary heart disease in Nashville, Tennesee . Circulation 1971;;44:884-890.
26 +
Keil JE, Saunders DE, Lackland DT, et al:  Acute myocardial infarction: Period prevalence, case fatality, and comparison of black and white cases in urban and rural areas of South Carolina . Am Heart J 1985;;109:776-784.
27 +
Weisse AB, Abiuso PD, Thind IS:  Acute myocardial infarction in Newark, NJ: A study of racial incidence . Arch Intern Med 1977;;137:1402-1405.
28 +
Sempos C, Cooper R, Kovar MG, et al:  Divergence of the recent trends in coronary mortality for the four major race-sex groups in the United States . Am J Public Health 1988;;78:1422-1427.
29 +
Dutton D:  Explaining the low use of health services by the poor . Am Soc Rev 1978;;43:348-368.
30 +
Hayward RA, Shapiro MF, Freeman HE, et al:  Inequities in health services among insured Americans . N Engl J Med 1988;;318:1507-1512.
31 +
Greenberg ER, Chute CG, Stukel T, et al:  Social and economic factors in the choice of lung cancer treatment . N Engl J Med 1988;;318:612-617.
32 +
Wennberg J, Gittelsohn A:  Small-area variations in health care delivery . Science 1982;;246:120-135.
33 +
Chassin MR, Brook RH, Park RE:  Variations in the use of medical and surgical services by the Medicare population . N Engl J Med 1986;;314:285-290.
34 +
Brook RH, Kosecoff JB, Park RE, et al:  Diagnosis and treatment of coronary disease: Comparison of doctor's attitudes in the USA and UK . Lancet 1988;;1:750-753.
35 +
Eisenberg JM:  Sociologic influences on medical decision making by clinicians . Ann Intern Med 1979;;90:957-964.
36 +
Egbert LD, Rothman IL:  Relation between race and economic status of patients and who performs their surgery . N Engl J Med 1977;;297:90-91.
37 +
Demlo LK, Campbell PM:  Improving hospital discharge data . Med Care 1981;;19:1030-1040.
38 +
Hsia DC, Krushat M, Fagan AB, et al:  Accuracy of diagnostic coding for Medicare patients under the prospective-payment system . N Engl J Med 1988;;318:352-355.
39 +
Iezzoni LI, Burnside S, Sickles L, et al:  Coding of acute myocardial infarction: Clinical and policy implications . Ann Intern Med 1988;;109:745-751.
40 +
Sloan FS, Valvona J, Mullner R:  Identifying the issues: A statistical profile , in Sloan F, Blumenstein J, Perrin J (eds): Uncompensated Hospital Care: Rights and Responsibilities . Baltimore, Johns Hopkins University Press, 1986;, pp 16-53.
41 +
Roos NP, Wennberg JE, McPherson K:  Using diagnosis-related groups for studying variations in hospital admissions . Health Care Financ Rev , (Summer) 1988;, p 53.

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