CAN CHARACTERISTICS OF A HEALTH-CARE SYSTEM MITIGATE ETHNIC BIAS IN ACCESS TO CARDIOVASCULAR PROCEDURES - EXPERIENCE FROM THE MILITARY HEALTH-SERVICES SYSTEM

Objectives. This study sought to investigate the independent effect of ethnicity on the utilization of invasive cardiac procedures after acu te myocardial infarction (AMI). Background. The precise role of ethnic ity in access to cardiovascular procedures is unknown, particularly be cause of difficulty in isolating ethnicity from financial and other so cioeconomic factors. We conducted a retrospective analysis of the use of cardiac catheterization and coronary revascularization procedures a fter AMI in military health care beneficiaries. The Military Health Se rvices System (MHSS) ensures equal access to care in an environment wi thout financial incentives for procedural utilization; furthermore, so cioeconomic differences between patients beyond ethnicity are minimize d. Methods. Data mere analyzed from the Civilian External Peer Review Program representing abstracted chart reviews from 125 military health care facilities worldwide for all patients (1,208 white; 235 nonwhite [155 black]) with the principal or secondary diagnosis of AMI from Ma rch to September 1993. Results. Rates of cardiac catheterization were similar in white add nonwhite patients (34.8 vs, 39.1%, p = 0.21). Aft er controlling for age, gender, cardiovascular risk factors and AMI va riables, including infarct size and other risk markers, there mere no differences in the use of this procedure during the AMI admission in c omparisons of white versus nonwhite patients (estimated odds ratio [OR ] 0.96, 95% confidence interval [CI] 0.69 to 1.34) End white versus bl ack patients (OR 1.19, 95% CI 0.80 to 1.78). However, white patients w ere significantly more likely than nonwhite patients to be ''considere d'' for future cardiac catheterization (OR 1.77, 95% CI 1.19 to 2.61). Coronary revascularization within 180 days was hot significantly affe cted by race in white versus nonwhite (OR 0.90, 95% CI 0.59 to 1.39) a nd white versus black patients (OR 1.11, 95% CI 0.65 to 1.89). Outcome s (30- and 180-day mortality and readmission rates) were similar far a ll race groups. Conclusions. There is a limited relation between ethni city and the use of invasive cardiac procedures in the MHSS. These dat a raise the promise that characteristics of a health care system can m itigate ethnic bias in medicine. (C) 1997 by the American College of C ardiology.