Variation in utilization of cardiac procedures in the Department of Veterans Affairs health care system: effect of race

Department of Veterans Affairs Medical Center, Memphis, Tennessee.

OBJECTIVES. Utilization rates for cardiac catheterization and cardiac surgery in the Department of Veterans Affairs (VA) health care system were studied to determine whether racial differences existed in a delivery plan in which access is not determined by patient finances. BACKGROUND. Prior studies have demonstrated significant differences in utilization of cardiac diagnostic and therapeutic resources by white and black patients. Reasons for the reduced utilization by black patients include socioeconomic, biologic and sociocultural effects. METHODS. Computerized discharge records of 30,300 patients with coronary artery disease and 1,335 patients with valvular heart disease who were discharged from any of 172 VA Medical Centers between October 1, 1990 and September 30, 1991 were studied. RESULTS. For patients with coronary artery disease, utilization rates of cardiac catheterization were significantly greater for white patients (503.4 procedures/1,000 patients) than for black patients (433.2/1,000 patients), with a relative odds ratio of 1.33. Rates for surgery (179.0 vs. 124.5/1,000 patients) were also greater for whites than for blacks, with a relative odds ratio of 1.53. For the subset with valve disease, the catheterization rate was significantly greater for whites than for blacks (575.4 vs. 432.6 procedures/1,000 patients), with a relative odds ratio of 1.78. Surgical rates were not significantly different (423.8 vs. 354.6 operations/1,000 patients). Racial differences for both catheterization and surgery varied widely as a function of geographic region and the level of complexity of the local VA facility. CONCLUSIONS. Racial differences in resource utilization exist in a health care system in which economic influences are minimized. The pattern of these differences depends on numerous variables and suggests both biologic and sociocultural factors as underlying causes.

This article has been cited by other articles:

				L. D. Woodard, N. R. Kressin, and L. A. Petersen Is Lipid-Lowering Therapy Underused by African Americans at High Risk of Coronary Heart Disease Within the VA Health Care System? Am J Public Health, December 1, 2004; 94(12): 2112 - 2117. [Abstract] [Full Text] [PDF]

				J. A. Long, V. W. Chang, S. A. Ibrahim, and D. A. Asch Update on the Health Disparities Literature Ann Intern Med, November 16, 2004; 141(10): 805 - 812. [Full Text] [PDF]

				T. A. LaVeist, M. Arthur, A. Morgan, S. Plantholt, and M. Rubinstein Explaining Racial Differences in Receipt of Coronary Angiography: The Role of Physician Referral and Physician Specialty Med Care Res Rev, December 1, 2003; 60(4): 453 - 467. [Abstract] [PDF]

				S. A. Ibrahim, J. Whittle, B. Bean-Mayberry, M. E. Kelley, C. Good, and J. Conigliaro Racial/Ethnic Variations in Physician Recommendations for Cardiac Revascularization Am J Public Health, October 1, 2003; 93(10): 1689 - 1693. [Abstract] [Full Text] [PDF]

				N. R. Kressin, B.-H. Chang, A. Hendricks, and L. E. Kazis Agreement Between Administrative Data and Patients' Self-Reports of Race/Ethnicity Am J Public Health, October 1, 2003; 93(10): 1734 - 1739. [Abstract] [Full Text] [PDF]

				T. A. LaVeist, M. Arthur, A. Morgan, M. Rubinstein, J. Kinder, L. M. Kinney, and S. Plantholt The cardiac access longitudinal study: A study of access to invasive cardiology among African American and white patients J. Am. Coll. Cardiol., April 2, 2003; 41(7): 1159 - 1166. [Abstract] [Full Text] [PDF]

				N. R. Kressin and L. A. Petersen Racial Differences in the Use of Invasive Cardiovascular Procedures: Review of the Literature and Prescription for Future Research Ann Intern Med, September 4, 2001; 135(5): 352 - 366. [Abstract] [Full Text] [PDF]

				S. Okelo, A. L. Taylor, J. T. Wright Jr, N. Gordon, G. Mohan, and E. Lesnefsky Race and the decision to refer for coronary revascularization: The effect of physician awareness of patient ethnicity J. Am. Coll. Cardiol., September 1, 2001; 38(3): 698 - 704. [Abstract] [Full Text] [PDF]

				J. W. Jones The question of racial bias in thoracic surgery: appearances and realities Ann. Thorac. Surg., July 1, 2001; 72(1): 6 - 8. [Full Text] [PDF]

				J. Chen, S. S. Rathore, M. J. Radford, Y. Wang, and H. M. Krumholz Racial Differences in the Use of Cardiac Catheterization after Acute Myocardial Infarction N. Engl. J. Med., May 10, 2001; 344(19): 1443 - 1449. [Abstract] [Full Text] [PDF]

				R. M. Mayberry, F. Mili, and E. Ofili Racial and Ethnic Differences in Access to Medical Care Med Care Res Rev, December 1, 2000; 57(4_suppl): 108 - 145. [Abstract] [PDF]

				A. Onwuanyi, D. Hodges, A. Avancha, L. Weiss, D. Rabinowitz, S. Shea, and C. K. Francis Hypertensive Vascular Disease as a Cause of Death in Blacks Versus Whites : Autopsy Findings in 587 Adults Hypertension, May 1, 1998; 31(5): 1070 - 1076. [Abstract] [Full Text] [PDF]

				E. D. Peterson, L. K. Shaw, E. R. DeLong, D. B. Pryor, R. M. Califf, and D. B. Mark Racial Variation in the Use of Coronary-Revascularization Procedures -- Are the Differences Real? Do They Matter? N. Engl. J. Med., February 13, 1997; 336(7): 480 - 486. [Abstract] [Full Text] [PDF]