Racial disparities in the use of cardiac revascularization: does local hospital capacity matter?

Abstract

ObjectiveTo 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 sourcesAdministrative data from Pennsylvania Health Care Cost Containment Council (PHC4) between 1995 and 2006.Study designThe 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 findingsBlacks were less likely than whites to receive CABG (9.1% vs. 5.8%; pConclusionsCounty 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.