RACIAL-DIFFERENCES IN THE USE OF INVASIVE CARDIOVASCULAR PROCEDURES IN THE DEPARTMENT-OF-VETERANS-AFFAIRS MEDICAL SYSTEM

Background. Previous studies have found racial differences in the use of invasive cardiovascular procedures, which may be due in part to the greater financial incentives to perform such procedures in white pati ents. In Department of Veterans Affairs hospitals, direct financial in centives affecting use of the procedures are minimized for both patien ts and physicians. Methods. We analyzed retrospectively the use of car diovascular procedures among black and white male veterans discharged from Veterans Affairs hospitals with primary diagnoses of cardiovascul ar disease or chest pain during fiscal years 1987 through 1991. We use d coded discharge data to determine whether cardiac catheterization, p ercutaneous transluminal coronary angioplasty, or coronary artery bypa ss grafting was performed during or immediately after such admissions. We used logistic-regression analysis to adjust for the primary discha rge diagnosis, the presence of coexisting conditions, age, marital sta tus, type of eligibility to receive care at Veterans Affairs hospitals , geographic region, and whether the hospital was equipped to perform bypass surgery. We classified the primary diagnosis as myocardial infa rction, unstable angina, angina, chronic ischemia, chest pain, or ''ot her'' cardiovascular diagnosis. Results. After we adjusted for all the potential confounders, we found that white veterans were more likely than black veterans to undergo cardiac catheterization (odds ratio, 1. 38; 95 percent confidence interval, 1.34 to 1.42), angioplasty (odds r atio, 1.50; 95 percent confidence interval, 1.38 to 1.64), and coronar y artery bypass surgery (odds ratio, 2.22; 95 percent confidence inter val, 2.09 to 2.36). Conclusions. Even when financial incentives are ab sent, whites are more likely than blacks to undergo invasive cardiac p rocedures. These findings suggest that social or clinical factors affe ct the use of these procedures differently in blacks and whites.