No racial difference in receipt of high-quality CHD care
MedWire News: Black patients with coronary heart disease (CHD) are equally or more likely to be admitted to a top-ranked hospital for acute myocardial infarction (AMI) treatment and coronary artery bypass graft (CABG) surgery in comparison with White patients with the same condition, a US study suggests.
However, in socially disadvantaged areas, Black patients with CHD have a lower likelihood of receiving CABG surgery at a top-ranked hospital than White CHD patients, say Ioana Popescu (University of Iowa Hospitals and Clinics) and team.
The team identified 286,947 White (n=255,153) and Black (n=31,794) patients admitted to hospitals offering treatment for emergency AMI and elective CABG.
All hospitals were ranked by the US News and World Report "America's Best Hospitals."
Using measures of poverty obtained from Census Tract data, the team arranged the zip codes of all patients into tertiles of social disadvantage, with the lowest, middle, and highest tertiles determining the areas of low, middle, and high social disadvantage, respectively.
As reported in the Archives of Internal Medicine the study findings showed that, overall, Black patients lived on average 14.56 km closer to top-ranked teaching hospitals, and were more commonly admitted to these hospitals compared with White patients, at a rate of 18.3% versus 10.5% for AMI, and 34.4% versus 22.7% for CABG patients (both p<0.001).
In areas of high social disadvantage, however, Black patients were 25% less likely to be admitted to top-ranked hospitals for CABG and AMI than White patients (p<0.001).
Overall, Black patients were more likely than White patients to "bypass" their closest top-ranked hospital and instead receive treatment at a non-top-ranked hospital up to 3.2 km away from their home, at 25.8% versus 14.7% for AMI, and 37.5% versus 26.% for CABG, (p<0.001 for both).
This trend for bypassing was also present in areas of high social disadvantage, with a 16% higher rate of bypassing for CABG among Black patients than White patients (p=0.03).
For AMI treatment, Black patients had a similar likelihood of bypassing top-ranked hospitals as White patients.
In an accompanying editorial, Michelle Albert (Brigham and Women's Hospital, Boston, Massachusetts, USA) highlighted design limitations which may have decreased the accuracy of the findings, namely the team's decision to use zip codes to infer socioeconomic status.
"Education data would be useful to more accurately define level of socioeconomic status," she said.
Popescu et al conclude: "Future research should focus on the complexity of geographical and social factors driving hospital choices for vulnerable populations."
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By Lauretta Ihonor