Journal article
Differences in admitting hospital characteristics for black and white Medicare beneficiaries with acute myocardial infarction
Circulation (New York, N.Y.), Vol.123(23), pp.2710-2716
06/14/2011
DOI: 10.1161/CIRCULATIONAHA.110.973628
PMCID: PMC3142883
PMID: 21632492
Abstract
Racial disparities in acute myocardial infarction treatment may be due to differences in admitting hospitals. Little is known about factors associated with hospital selection for black and white acute myocardial infarction patients.
We identified black and white Medicare beneficiaries with acute myocardial infarction in 63 hospital referral regions with at least 50 black admissions during 2005 (n=65,633). We calculated distance from patient home to hospital referral region hospitals using ZIP code centroids. We assessed hospital quality using a composite score made up of hospital risk-adjusted 30-day mortality and acute myocardial infarction performance measures. Hospitals with a score in the top 20% were categorized as high quality, and those in the lowest 20% as low quality. We used conditional multinomial logit models to examine differences in hospital selection for blacks and whites. On average, blacks lived closer to revascularization hospitals (mean, 3.8 versus 6.8 miles; P<0.001) and to high-quality hospitals (mean, 5.6 versus 9.7 miles; P<0.001). After distance was accounted for, blacks were relatively less likely (P<0.001) to be admitted to revascularization hospitals (risk ratio [RR], 0.87; 95% confidence interval [CI], 0.80 to 0.95) and to high-quality hospitals (RR, 0.88; 95% CI, 0.801 to 0.95) but more likely (P<0.001) to be admitted to low-quality hospitals (RR, 1.17; 95% CI, 1.05 to 1.29). In analyses matched by home ZIP code, differences in admissions to revascularization (RR, 0.92; 95% CI, 0.80 to 1.05), high-quality (RR, 0.94; 95% CI, 0.81 to 1.07), and low-quality (RR, 1.15; 95% CI, 0.94 to 1.35) hospitals were not significant.
Differences in admissions to revascularization and high-quality hospitals may contribute to disparities in acute myocardial infarction care. These differences may be due in part to residential ZIP code characteristics.
Details
- Title: Subtitle
- Differences in admitting hospital characteristics for black and white Medicare beneficiaries with acute myocardial infarction
- Creators
- Ioana Popescu - Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA. IPopescu@mednet.ucla.eduPeter CramMary S Vaughan-Sarrazin
- Resource Type
- Journal article
- Publication Details
- Circulation (New York, N.Y.), Vol.123(23), pp.2710-2716
- DOI
- 10.1161/CIRCULATIONAHA.110.973628
- PMID
- 21632492
- PMCID
- PMC3142883
- NLM abbreviation
- Circulation
- ISSN
- 0009-7322
- eISSN
- 1524-4539
- Publisher
- Lippincott Williams & Wilkins; United States
- Grant note
- R01 HL085347 / NHLBI NIH HHS HL095930-01 / NHLBI NIH HHS K08 HL095930 / NHLBI NIH HHS K08 HL095930-02 / NHLBI NIH HHS R01 HL085347-01A1 / NHLBI NIH HHS
- Language
- English
- Date published
- 06/14/2011
- Academic Unit
- Health Management and Policy; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984064188702771
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