Journal article
Racial Disparities in Revascularization Rates Among Patients With Similar Insurance Coverage
Journal of the National Medical Association, Vol.101(11), pp.1132-1139
11/2009
DOI: 10.1016/S0027-9684(15)31109-3
PMID: 19998642
Abstract
Racial disparities in coronary revascularization—percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG)—have been extensively documented. However, it is unclear whether disparities are consistent among patients with similar health insurance coverage. Our objective was to assess racial disparities in coronary revascularization among white, black, and Hispanic patients with similar insurance coverage hospitalized with acute myocardial infarction (AMI).
We used 2000-2005 state inpatient data for 9 states to identify white, black, and Hispanic patients hospitalized with AMI. Patients were grouped into 3 health insurance cohorts: (1) Medicare, (2) private insurance, and (3) Medicaid/uninsured. We examined use of revascularization (PCI or CABG) among blacks and Hispanics as compared to whites in each of the 3 insurance cohorts.
The 418 study hospitals admitted 430 509 AMI patients with Medicare, 238 956 with private insurance, and 74 926 patients who were uninsured/Medicaid. In unadjusted analyses, black and Hispanic patients were significantly less likely to receive in-hospital revascularization among the Medicare cohort (38.9% vs 44.9% vs 47.3%, P < .001), privately insured cohort (62.9% vs 69.7% vs 74.2%, P < .001), and uninsured/Medicaid cohort (55.2% vs 61.0% vs 68.4%, P < .001). In Cox models adjusting for patient demographics, comorbidity, and clustering of patients within hospitals, blacks were approximately 25% less likely and Hispanics 5% less likely to receive revascularization as compared to whites with similar insurance.
Blacks hospitalized with AMI are significantly less likely to receive revascularization when compared to whites and Hispanics with similar health insurance. Our data suggest that patients’ ability to pay for costly procedures is unlikely to explain racial disparities.
Details
- Title: Subtitle
- Racial Disparities in Revascularization Rates Among Patients With Similar Insurance Coverage
- Creators
- Peter Cram - Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IowaLevent Bayman - Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IowaIoana Popescu - Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IowaMary S Vaughan-Sarrazin - Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Resource Type
- Journal article
- Publication Details
- Journal of the National Medical Association, Vol.101(11), pp.1132-1139
- Publisher
- Elsevier Inc
- DOI
- 10.1016/S0027-9684(15)31109-3
- PMID
- 19998642
- ISSN
- 0027-9684
- eISSN
- 1943-4693
- Language
- English
- Date published
- 11/2009
- Academic Unit
- Health Management and Policy; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984063122002771
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