Background Previous studies have found racial differences inthe use of invasive cardiovascular procedures, which may bedue in part to the greater financial incentives to perform suchprocedures in white patients. In Department of Veterans Affairshospitals, direct financial incentives affecting use of theprocedures are minimized for both patients and physicians.
Methods We analyzed retrospectively the use of cardiovascularprocedures among black and white male veterans discharged fromVeterans Affairs hospitals with primary diagnoses of cardiovasculardisease or chest pain during fiscal years 1987 through 1991.We used coded discharge data to determine whether cardiac catheterization,percutaneous transluminal coronary angioplasty, or coronaryartery bypass grafting was performed during or immediately aftersuch admissions. We used logistic-regression analysis to adjustfor the primary discharge diagnosis, the presence of coexistingconditions, age, marital status, type of eligibility to receivecare at Veterans Affairs hospitals, geographic region, and whetherthe hospital was equipped to perform bypass surgery. We classifiedthe primary diagnosis as myocardial infarction, unstable angina,angina, chronic ischemia, chest pain, or "other" cardiovasculardiagnosis.
Results After we adjusted for all the potential confounders,we found that white veterans were more likely than black veteransto undergo cardiac catheterization (odds ratio, 1.38; 95 percentconfidence interval, 1.34 to 1.42), angioplasty (odds ratio,1.50; 95 percent confidence interval, 1.38 to 1.64), and coronaryartery bypass surgery (odds ratio, 2.22; 95 percent confidenceinterval, 2.09 to 2.36).
Conclusions Even when financial incentives are absent, whitesare more likely than blacks to undergo invasive cardiac procedures.These findings suggest that social or clinical factors affectthe use of these procedures differently in blacks and whites.
Source Information
From the Section of General Internal Medicine, Pittsburgh Veterans Affairs Medical Center, and the Section of General Internal Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh.
Address reprint requests to Dr. Whittle at the Pittsburgh VA Medical Center (11A), University Drive C, Pittsburgh, PA 15240.
Heart Disease and Race
Lai S., Page J. B., Rodney E., Vasavada B. C., Sacchi T. J., Platt F. W., Becker L. B., Meyer P. M., Whittle J., Conigliaro J., Good C.B.
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N Engl J Med 1994;
330:216-218, Jan 20, 1994.
Correspondence
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