ACCESS TO HOSPITALS WITH HIGH-TECHNOLOGY CARDIAC SERVICES - HOW IS RACE IMPORTANT

Objectives. Relatively few hospitals in the United States offer high-t echnology cardiac services (cardiac catheterization, bypass surgery, o r angioplasty). This study examined the association between race and a dmission to a hospital offering those services. Methods. Records of 11 410 patients admitted With acute myocardial infarction to hospitals i n New York State in 1986 were analyzed. Results. Approximately one thi rd of both White and Black patients presented to hospitals offering hi gh-technology cardiac services. However, in a multivariate model adjus ting for home-to-hospital distance, the White-to-Black odds ratio for likelihood of presentation to such a hospital was 1.68 (95% confidence interval = 1.42, 1.98). This discrepancy between the observed and ''d istance-adjusted'' probabilities reflected three phenomena: (1) patien ts presented to nearby, hospitals; (2) Blacks were more likely to live near high-technology hospitals; and (3) there were racial differences in travel patterns. For example, when the nearest hospitals did not i nclude a high-technology hospital, Whites were: more likely than Black s to travel beyond those nearest hospitals to a high-technology hospit al. Conclusions. Whites and Blacks present equally to hospitals offeri ng high-technology cardiac services at the time of acute myocardial in farction However, there are important underlying racial differences in geographic proximity and tendencies to travel to those hospitals.