Racial Disparities in the Use of Cardiac Revascularization: Does Local Hospital Capacity Matter?

PloS One, Vol. 8, No. 7, July 2013

10 Pages Posted: 27 Jun 2014

See all articles by Suhui Li

Suhui Li

George Washington University

Arnold Chen

Mathematica Policy Research, Inc.

Katherine Mead

George Washington University

Date Written: 2013

Abstract

Objective. To assess the extent to which the observed racial disparities in cardiac revascularization use can be explained by the variation across counties where patients live, and how the within-county racial disparities is associated with the local hospital capacity.

Data Sources. Administrative data from Pennsylvania Health Care Cost Containment Council (PHC4) between 1995 and 2006.

Study Design. The study sample included 207,570 Medicare patients admitted to hospital for acute myocardial infarction (AMI). We identified the use of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) procedures within three months after the patient’s initial admission for AMI. Multi-level hierarchical models were used to determine the extent to which racial disparities in procedure use were attributable to the variation in local hospital capacity.

Principal Findings. Blacks were less likely than whites to receive CABG (9.1% vs. 5.8%; p<0.001) and PCI (15.7% vs. 14.2%; p<0.001). The state-level racial disparity in use rate decreases for CABG, and increases for PCI, with the county adjustment. Higher number of revascularization hospitals per 1,000 AMI patients was associated with smaller within-county racial differences in CABG and PCI rates. Meanwhile, very low capacity of catheterization suites and AMI hospitals contributed to significantly wider racial gap in PCI rate.

Conclusions. County variation in cardiac revascularization use rates helps explain the observed racial disparities. While smaller hospital capacity is associated with lower procedure rates for both racial groups, the impact is found to be larger on blacks. Therefore, consequences of fewer medical resources may be particularly pronounced for blacks, compared with whites.

Keywords: cardiac revascularization; racial disparities; geographic variation; hospital capacity

Suggested Citation

Li, Suhui and Chen, Arnold and Mead, Katherine, Racial Disparities in the Use of Cardiac Revascularization: Does Local Hospital Capacity Matter? (2013). PloS One, Vol. 8, No. 7, July 2013. Available at SSRN: https://ssrn.com/abstract=2459257

Suhui Li (Contact Author)

George Washington University ( email )

950 New Hampshire Ave.
Washington, DC 20052
United States

Arnold Chen

Mathematica Policy Research, Inc. ( email )

P.O. Box 2393
Princeton, NJ 08543-2393
United States

Katherine Mead

George Washington University ( email )

950 New Hampshire Ave.
Washington, DC 20052
United States

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