Key result
Black AMI patients are ~12% more likely admitted to top hospitals than whites, unlike disadvantaged CABG patients.
Why the study?
Little is known about racial differences in admission to high-quality hospitals for patients with coronary heart disease.
Does black race affect the likelihood of admission to high-quality hospitals in Medicare patients with AMI or undergoing CABG compared to white race?
Observational
Yes
Does black race affect the likelihood of admission to high-quality hospitals in Medicare patients with AMI or undergoing CABG compared to white race?
Odds Ratio: 1.12 (95% CI 1.08–1.16)
Absolute Event Rate: 18.3% vs 10.5%
p-value: p=< .001
While overall admission rates to top-ranked cardiac hospitals are similar or higher for black Medicare patients compared to whites, significant disparities exist for socially disadvantaged black patients undergoing CABG.
Black patients reached top hospitals at similar or higher rates after distance adjustment; leaves open socioeconomic barriers for disadvantaged CABG subgroups.
BACKGROUND: Research increasingly shows that blacks with coronary heart disease (CHD) are treated at lower-quality hospitals. Little is known about racial differences in admission to high-quality hospitals. METHODS: We identified all black and white Medicare patients with acute myocardial infarction and coronary artery bypass grafting (CABG) admitted during 2002 through 2005 to hospitals located in markets with top-ranked cardiac hospitals, as ascertained from the US News and World Report "America's Best Hospitals" annual rankings. The relationship between race and admission to top-ranked hospitals was estimated using multinomial conditional logit models to account for distance from patient residence to all available hospitals. RESULTS: In unadjusted analyses, blacks with AMI or undergoing CABG, compared with whites, were more likely to be admitted to top-ranked hospitals (18.3% vs 10.5% and 34.4% vs 22.7% [P < .001]) but also more likely to bypass top-ranked hospitals (25.8% vs 14.7% and 37.5% vs 26.3% [P < .001]). In models accounting for distance, blacks with acute myocardial infarction were more likely (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.08-1.16 [P < .001]), whereas blacks undergoing CABG were equally likely (OR, 1.05; 95% CI, 0.97-1.13; P = .27) to be admitted to top-ranked hospitals compared with whites. However, within socially disadvantaged zip codes, blacks undergoing CABG were less likely to receive care at top-ranked hospitals (OR, 0.75; 95% CI, 0.64-0.86 [P < .001]) compared with whites and more likely to bypass top-ranked hospitals located closer to their residence (OR, 1.16; 95% CI, 1.02-1.30 [P = .03]). CONCLUSION: Black Medicare patients with acute myocardial infarction or undergoing CABG were equally or more likely to be admitted to top-ranked hospitals, except for socially disadvantaged black patients undergoing CABG.
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Popescu et al. (2010) conducted an observational in Acute myocardial infarction and coronary artery bypass grafting (CABG). Black race vs. White race was evaluated on Admission to top-ranked hospitals for acute myocardial infarction (OR 1.12, 95% CI 1.08-1.16, p=< .001). Accounting for distance, black patients with AMI were more likely to be admitted to top-ranked hospitals than whites (OR 1.12), while socially disadvantaged black CABG patients were less likely.