Patient and hospital differences underlying racial variation in outcomes after coronary artery bypass graft surgery

Suma H Konety; Mary S Vaughan Sarrazin; Gary E Rosenthal

doi:10.1161/01.CIR.0000157728.49918.9F

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Patient and hospital differences underlying racial variation in outcomes after coronary artery bypass graft surgery

Journal article

Open access

Peer reviewed

Patient and hospital differences underlying racial variation in outcomes after coronary artery bypass graft surgery

Suma H Konety, Mary S Vaughan Sarrazin and Gary E Rosenthal

Circulation (New York, N.Y.), Vol.111(10), pp.1210-1216

03/15/2005

DOI: 10.1161/01.CIR.0000157728.49918.9F

PMID: 15769760

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Abstract

Few studies have examined the association of race and outcomes after coronary artery bypass graft (CABG) surgery while controlling for both patient and hospital effects. We retrospectively analyzed data on a cohort of 566,785 white and 24,354 black Medicare beneficiaries 65 years old and older undergoing CABG in 1091 US hospitals from 1997 to 2000. Mortality and repeat revascularization rates were examined after sequential adjustment for patient and hospital differences by use of generalized estimating equations. Unadjusted mortality was higher (P<0.001) in black than in white patients at 30 (6.4% versus 5.2%), 90 (8.3% versus 6.6%), and 365 days (13.5% versus 9.8%) after surgery. Black patients were more likely (P<0.001) to undergo CABG at hospitals with the highest mortality (56% versus 47%) and at hospitals in the lowest volume quintile (24% versus 20%). Adjusted only for patient characteristics, mortality was 8%, 11%, and 25% higher in black patients at 30, 90, and 365 days. After adjustment for hospital effects, 30 and 90 day mortality was similar but 17% higher in black patients at 365 days. Racial differences in mortality were greater in men than in women. On adjustment for patient and hospital effects, repeat revascularization rates were similar in black and white patients. Racial disparities in CABG outcomes are sensitive to the effects of sex and duration of postsurgical follow-up. The increasing disparity in outcomes as follow-up increased is consistent with the hypothesis that black patients have less access to secondary prevention and rehabilitation services after surgery.

United States - epidemiology

Hospital Mortality

Comorbidity

Humans

Medicare - statistics & numerical data

Income

European Continental Ancestry Group - statistics & numerical data

Male

Treatment Outcome

African Americans - statistics & numerical data

Coronary Artery Bypass - mortality

Hospitals - statistics & numerical data

Reoperation - statistics & numerical data

Sex Factors

Aged, 80 and over

Coronary Artery Bypass - statistics & numerical data

Female

Aged

Retrospective Studies

Cohort Studies

Details

Title: Subtitle: Patient and hospital differences underlying racial variation in outcomes after coronary artery bypass graft surgery
Creators: Suma H Konety - Division of Cardiology, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
Mary S Vaughan Sarrazin
Gary E Rosenthal
Resource Type: Journal article
Publication Details: Circulation (New York, N.Y.), Vol.111(10), pp.1210-1216
DOI: 10.1161/01.CIR.0000157728.49918.9F
PMID: 15769760
NLM abbreviation: Circulation
ISSN: 0009-7322
eISSN: 1524-4539
Publisher: Lippincott Williams & Wilkins; United States
Grant note: 5-T32-HL-07121-28 / NHLBI NIH HHS
Language: English
Date published: 03/15/2005
Academic Unit: Health Management and Policy; General Internal Medicine; Internal Medicine
Record Identifier: 9984064185602771

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