Treatment variation in older black and white patients undergoing aortic valve replacement

Erik B SCHELBERT; Gary E ROSENTHAL; Karl F WELKE; Mary S VAUGHAN-SARRAZIN

doi:10.1161/CIRCULATIONAHA.104.530550

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Treatment variation in older black and white patients undergoing aortic valve replacement

Journal article

Open access

Peer reviewed

Treatment variation in older black and white patients undergoing aortic valve replacement

Erik B SCHELBERT, Gary E ROSENTHAL, Karl F WELKE and Mary S VAUGHAN-SARRAZIN

Circulation (New York, N.Y.), Vol.112(15), pp.2347-2353

2005

DOI: 10.1161/CIRCULATIONAHA.104.530550

PMID: 16203916

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https://doi.org/10.1161/CIRCULATIONAHA.104.530550View

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Abstract

Background: Most prior studies of racial differences in the delivery of cardiac care have focused on potential differences in treatment by individual physicians and hospitals. However, differential use of hospitals with variable practice patterns might also contribute to variations in care. Methods and results: We compared the use of bioprosthetic valves (BPVs) in 78,154 black and white Medicare beneficiaries > or =65 years of age undergoing aortic valve replacement in 904 US hospitals during 1999 through 2001. Generalized linear mixed models were used to account first for differences in patient characteristics and then for differences in hospitals used by black and white patients. BPV use was lower in black patients relative to white patients after adjustment for patient characteristics (relative risk, 0.93; 95% CI, 0.91 to 0.95; P<0.001). However, black patients were more likely to undergo surgery in hospitals in the lowest quintile of BPV use overall (29% versus 20% of white patients; P<0.001). After hospital-level variability in BPV use was accounted for, the use of BPVs was actually somewhat higher in black patients (relative risk, 1.06; 95% CI, 1.04 to 1.09; P<0.001). Model discrimination as measured by the c statistic was markedly higher after the addition of hospital effects (0.80 versus 0.59 for patient characteristics alone; P<0.001). Conclusions: Accounting for differences in hospitals preferentially used by black and white patients had a major impact on estimating racial differences in the use of BPVs in patients undergoing aortic valve replacement. Hospital-level effects explained a larger proportion of the variation in BPV use than race and other patient characteristics alone.

Cardiovascular System

Cardiology. Vascular system

Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous

Pharmacology. Drug treatments

Biological and medical sciences

Medical sciences

Vasodilator agents. Cerebral vasodilators

Blood and lymphatic vessels

Diseases of the aorta

Details

Title: Subtitle: Treatment variation in older black and white patients undergoing aortic valve replacement
Creators: Erik B SCHELBERT - Divisions of Cardiovascular Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
Gary E ROSENTHAL - Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
Karl F WELKE - Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health and Science University, Portland, United States
Mary S VAUGHAN-SARRAZIN - Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
Resource Type: Journal article
Publication Details: Circulation (New York, N.Y.), Vol.112(15), pp.2347-2353
DOI: 10.1161/CIRCULATIONAHA.104.530550
PMID: 16203916
NLM abbreviation: Circulation
ISSN: 0009-7322
eISSN: 1524-4539
Publisher: Lippincott Williams & Wilkins; Hagerstown, MD
Language: English
Date published: 2005
Academic Unit: Health Management and Policy; General Internal Medicine; Internal Medicine
Record Identifier: 9984064186002771

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