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BLACK VETERANS HAVE FEWER CARDIOVASCULAR PROCEDURES.

Several large studies in the fee-for-service setting suggest that blacks undergo fewer invasive cardiovascular procedures than whites. This study found a similar trend in hospitals of the U.S. Department of Veterans Affairs, in which financial considerations are less likely to affect medical decisions.

Researchers analyzed 428,000 admissions for cardiovascular disease or chest pain between 1987 and 1991, adjusting for coexisting conditions, age, marital status, geographic region, and whether or not the hospital performed bypass surgery. White veterans were more likely than blacks to undergo catheterization (odds ratio, 1.38), angioplasty (OR, 1.50), and coronary-artery bypass surgery (OR, 2.22). When the analysis was restricted to veterans with limited income, results were essentially the same.

Comment: This study shows that the utilization of invasive cardiovascular procedures differs by race even when financial pressures are minimized. Thus, it strongly suggests that utilization is influenced by social factors, such as patient or physician attitudes, poor interracial communication, or outright racial bias.

— ALK

Published in Journal Watch General Medicine September 14, 1993

Citation(s):

Ayanian JZ. Heart disease in black and white. N Engl J Med 1993 Aug 26 329 656-658.

• Original article (Subscription may be required)
• Medline abstract (Free)

Whittle J et al. Racial differences in the use of invasive cardiovascular procedures in the Department of Veterans Affairs medical system. N Engl J Med 1993 Aug 26 329 621-627.

• Original article (Subscription may be required)
• Medline abstract (Free)