Operative and Late Coronary Artery Bypass Grafting Outcomes in Matched African-American Versus Caucasian Patients
Evidence of a Late Survival-Medicaid Association
Anoar Zacharias, MD*, ,
Thomas A. Schwann, MD*,,
Christopher J. Riordan, MD*,,
Samuel J. Durham, MD*,,
Aamir Shah, MD*, and
Robert H. Habib, PhD*, ,*
* Division of Cardiovascular Surgery, St. Vincent Mercy Medical Center
Surgery
Medicine, College of Medicine, The Medical University of Ohio, Toledo, Ohio
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Figure 1 (Top) Annual distribution of Caucasian, African-American, and Hispanic/Other coronary artery bypass grafting (CABG) patients at Saint Vincent Mercy Medical Center between 1991 and 2003. (Bottom) Annual distribution of Medicare, Medicaid, private insurance, and uninsured among CABG patients at Saint Vincent Mercy Medical Center between 1991 and 2003.
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Figure 2 Overall unadjusted Kaplan-Meier 0- to 12-year survival in African-American (AA) (thick lines) versus Caucasian (thin line) coronary artery bypass graft (CABG) patients (patient characteristics are summarized in Table 1). Hazard ratio is calculated from Cox proportional hazard regression with race as a single covariate.
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Figure 3 (Left) Propensity-adjusted survival derived by proportional hazard Cox regression analysis with race and propensity score (parsimonious model) included as covariates. Dashed line = survival at mean of covariates. (Right) Kaplan-Meier 0- to 12-year coronary artery bypass graft (CABG) survival in matched African-American (AA) (thick lines) versus Caucasian (thin line) patients. Corresponding non-parsimonious model results were essentially identical (see Fig. S2 of the online version of this article).
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Figure 4 (Top left) Unadjusted 0- to 12-year Kaplan-Meier (K-M) survival in unmatched Medicaid (triangles, thick line) versus non-Medicaid (thin line) coronary artery bypass graft (CABG) patients. (Top middle) Propensity-adjusted comparison of survival in Medicaid (thick line) versus non-Medicaid (thin line) CABG patients with additional Medicare coverage. (Top right) Propensity-adjusted comparison of survival in Medicaid (thick line) versus non-Medicaid (thin line) CABG non-Medicare patients. (Bottom left) Unadjusted 0- to 12-year Kaplan-Meier survival in one-to-one propensity-matched Medicaid (thick line) versus non-Medicaid (thin line) CABG patients: Medicare (black), non-Medicare (gray). (Bottom Right) Ten-year relative death hazard functions (Medicaid yes/no) for all patients (black, thin), Medicare cohort (black, thick), and non-Medicare cohort (gray) derived from analyses of propensity-matched survival data. CI = confidence interval.
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