RACIAL-DIFFERENCES IN THE USE OF REVASCULARIZATION PROCEDURES AFTER CORONARY ANGIOGRAPHY

Objective.-To assess whether rates of coronary revascularization proce dures differ between blacks and whites after coronary angiography is p erformed and to assess the relationship of these rates to hospital cha racteristics. Design.-A retrospective cohort study using 1987 and 1988 data on hospital claims and characteristics from the Health Care Fina ncing Administration. Setting.-One thousand four hundred twenty-nine a cute care hospitals that provide coronary angiography in the United St ates. Patients.-A national sample of 27 485 Medicare Part A enrollees, aged 65 to 74 years, who underwent inpatient angiography for coronary heart disease in 1987. Main Outcome Measure.-The adjusted odds of rev ascularization with either coronary angioplasty or bypass graft surger y within 90 days of angiography for whites relative to blacks, control ling for age, sex, region, Medicaid eligibility, principal diagnosis, comorbid diagnoses, and hospital characteristics of ownership, teachin g status, urban/suburban or rural location, and availability of revasc ularization procedures. Results.-White men and women were significantl y more likely than black men and women, respectively, to receive a rev ascularization procedure after coronary angiography (57% and 50% vs 40 % and 34%, both P<.001). The adjusted odds of receiving a revasculariz ation procedure after coronary angiography were 78% higher for whites than blacks (95% confidence interval for odds ratio, 1.56 to 2.03). St atistically significant racial differences in the adjusted odds of rec eiving a revascularization procedure were present in all types of hosp itals except rural hospitals, and these differences did not vary signi ficantly by any of the four hospital characteristics (all P>.20 for in teraction terms). Conclusions.-Among Medicare enrollees, whites are mo re likely than blacks to receive revascularization procedures after co ronary angiography. Racial differences of similar magnitude occur in a ll types of hospitals. These differences may reflect overuse in whites or underuse in blacks, but they are unlikely to reflect access to car diologists or hospitals that perform revascularization procedures. Pot ential explanations include unmeasured clinical or socioeconomic facto rs, differing patient preferences, and racial bias at the hospitals pe rforming angiography.