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Coronary Revascularization at Specialty Cardiac Hospitals and Peer General Hospitals in Black Medicare Beneficiaries

From the Health Services Research and Development Center of Excellence (B.K.N.), Ann Arbor VA Medical Center, Ann Arbor, Mich; and CRIISP Health Services Research and Development Center of Excellence (X.L., M.S.V.-S., P.C.), Iowa City VA Medical Center, Iowa City, Iowa.

Correspondence to Dr Nallamothu, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0366. E-mail bnallamo{at}umich.edu

Received June 17, 2008; accepted September 23, 2008.

Background— Critics have raised concerns that specialty cardiac hospitals exacerbate racial disparities in cardiovascular care, but empirical data are limited.

Methods and Results— We used administrative data from the Medicare Provider and Analysis Review Part A and Provider-of-Service files from 2002 to 2005. Multivariable logistic regression models were constructed to examine the likelihood of black Medicare patients being admitted to a cardiac hospital for coronary revascularization when compared with white patients within the same healthcare referral region after accounting for geographic proximity to the nearest hospitals, procedural acuity, and comorbidities. We identified 35 309 patients who underwent coronary artery bypass grafting in 18 healthcare referral regions and 94 525 patients who underwent percutaneous coronary intervention in 20 healthcare referral regions where cardiac hospitals performed these procedures. Patients at cardiac hospitals were more likely to be men and white and have less comorbidity than those at general hospitals. The likelihood of black patients undergoing coronary revascularization at a cardiac hospital was significantly lower for coronary artery bypass grafting (adjusted odds ratio, 0.67; P=0.01) and percutaneous coronary intervention (adjusted odds ratio, 0.63; P<0.0001). However, this relationship was substantially attenuated among black patients living in close proximity (ie, within 10 miles) to cardiac hospitals (adjusted odds ratio for coronary artery bypass grafting, 0.95; P=0.75; adjusted odds ratio for percutaneous coronary intervention, 0.78; P=0.01).

Conclusions— Black patients were significantly less likely to be admitted at cardiac hospitals for coronary revascularization. Precise reasons for these findings are unclear but suggest complex associations between race and geography in decisions about where to receive care.

Key Words: coronary revascularization • racial disparities • specialty hospitals

The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, the Department of Veterans Affairs, or the Agency for Healthcare Research and Quality, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. The authors assume full responsibility for the accuracy and completeness of the ideas presented.

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