Access to hospitals with high-technology cardiac services: how is race important?

OBJECTIVES: Relatively few hospitals in the United States offer high-technology cardiac services (cardiac catheterization, bypass surgery, or angioplasty). This study examined the association between race and admission to a hospital offering those services. METHODS: Records of 11,410 patients admitted with acute myocardial infarction to hospitals in New York State in 1986 were analyzed. RESULTS: Approximately one third of both White and Black patients presented to hospitals offering high-technology cardiac services. However, in a multivariate model adjusting for home-to-hospital distance, the White-to-Black odds ratio for likelihood of presentation to such a hospital was 1.68 (95% confidence interval = 1.42, 1.98). This discrepancy between the observed and "distance-adjusted" probabilities reflected three phenomena: (1) patients presented to nearby hospitals; (2) Blacks were more likely to live near high-technology hospitals; and (3) there were racial differences in travel patterns. For example, when the nearest hospitals did not include a high-technology hospital, Whites were more likely than Blacks to travel beyond those nearest hospitals to a high-technology hospital. CONCLUSIONS: Whites and Blacks present equally to hospitals offering high-technology cardiac services at the time of acute myocardial infarction. However, there are important underlying racial differences in geographic proximity and tendencies to travel to those hospitals.