Eric C. Schneider, MD, MSc; Lucian L. Leape, MD; Joel S. Weissman, PhD; Robert N. Piana, MD; Constantine Gatsonis, PhD; Arnold M. Epstein, MD, MA
Acknowledgments: The authors thank David Bates for comments on an earlier version of the manuscript; Margaret Volya and Jie Zheng for programming assistance; Marissa Hendrickson and Andrew Ellner for assistance with data collection; Marian Hendershot and the staff of the participating Peer Review Organizations, without whom this project would not have been possible; and Jeffrey Adams and Anne Hudson for assistance in preparing the manuscript.
Grant Support: By grant 5-RO-HS07098-02S1 from the Agency for Health Care Policy and Research.
Requests for Single Reprints: Eric C. Schneider, MD, MSc, Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115.
Current Author Addresses: Drs. Schneider, Leape, and Epstein: Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115.
Dr. Weissman: Institute for Health Policy, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02115.
Dr. Piana: Division of Cardiology, Vanderbilt University Medical Center, 2311 Pierce Avenue, Nashville, TN 37232-8802.
Dr. Gatsonis: Center for Statistical Sciences, Brown University Box G-H, 167 Angell Street, 2nd Floor, Providence, RI 02912.
Author Contributions: Conception and design: E.C. Schneider, L.L. Leape, J.S. Weissman, C. Gatsonis, A.M. Epstein.
Analysis and interpretation of the data: E.C. Schneider, L.L. Leape, J.S. Weissman, R.N. Piana, C. Gatsonis, A.M. Epstein.
Drafting of the article: E.C. Schneider, J.S. Weissman, A.M. Epstein.
Critical revision of the article for important intellectual content: E.C. Schneider, L.L. Leape, J.S. Weissman, R.N. Piana, C. Gatsonis, A.M. Epstein.
Final approval of the article: E.C. Schneider, L.L. Leape, J.S. Weissman, C. Gatsonis, A.M. Epstein.
Statistical expertise: C. Gatsonis.
Obtaining of funding: C. Gatsonis, A.M. Epstein.
Administrative, technical, or logistic support: E.C. Schneider, A.M. Epstein.
Collection and assembly of data: E.C. Schneider, J.S. Weissman, R.N. Piana, A.M. Epstein.
Schneider E., Leape L., Weissman J., Piana R., Gatsonis C., Epstein A.; Racial Differences in Cardiac Revascularization Rates: Does “Overuse” Explain Higher Rates among White Patients?. Ann Intern Med. 2001;135:328-337. doi: 10.7326/0003-4819-135-5-200109040-00009
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Published: Ann Intern Med. 2001;135(5):328-337.
Coronary artery bypass graft (CABG) surgery and percutaneous transluminal coronary angioplasty (PTCA) are well-established and widely used treatments for symptomatic coronary artery disease (1-3). In the United States during 1998, 553 000 CABG surgeries and 539 000 PTCA procedures were performed. Fifty-three percent of these procedures were performed in patients 65 years of age or older (4).
Previous studies have documented racial differences in rates of cardiac revascularization (5-8). White patients are approximately twice as likely as African-American patients to receive CABG surgery and 50% to 70% more likely to receive PTCA, after adjustment for confounding factors such as age, sex, and diagnosis. Among Medicare beneficiaries, these disparities by race are seen in all regions of the United States and have persisted over time (9). These findings are particularly striking because African-American patients are more likely to experience adverse effects from cardiovascular disease (10). The widening ratio of deaths from ischemic heart disease between African-American patients and white patients suggests that, if anything, African-American patients ought to have higher rates of revascularization than white patients.
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Cardiology, Coronary Heart Disease, Percutaneous Coronary Intervention.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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