Disparities/Minority Health

Blacks are more likely than whites and Hispanics to die following cardiovascular procedures, despite hospital experience

Black and Hispanic patients are more likely to undergo cardiovascular procedures in hospitals that perform a low volume of such procedures, and these hospitals usually have poorer outcomes than high-volume hospitals with more expertise. However, a new study shows that even after adjusting for differences in hospital volume, black patients were more likely than Hispanic and white patients to die after undergoing cardiovascular procedures. These findings suggest that hospital characteristics other than the number of procedures performed, such as financial resources, provider staffing, and availability of ancillary services, may be different in hospitals providing care to large numbers of minority patients.

Researchers, supported in part by the Agency for Healthcare Research and Quality (T32 HS00020), examined racial and ethnic differences in postoperative mortality for 719,679 hospitalizations for 4 cardiovascular procedures: cardiac artery bypass grafting (CABG), percutaneous transluminal coronary angioplasty (PTCA), abdominal aortic aneurysm (AAA) repair, and carotid endarterectomy (CEA). They used 1998 to 2001 data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project.

Blacks had nearly twice the risk of dying than whites after elective AAA repair, 19 percent greater risk after CABG, and nearly twice the risk after CEA, but did not have any greater risk of dying after PTCA. Hispanic patients were at no greater risk of dying after these procedures than whites. Both blacks and Hispanics had higher rates of urgent and emergency (rather than elective) AAA repair. This suggests inadequate screening or delayed referrals for surgery among Hispanic and black patients with aortic aneurysms.

More details are in "Impact of hospital volume on racial disparities in cardiovascular procedure mortality," by Amal N. Trivedi, M.D., M.P.H., Thomas D. Sequist, M.D., M.P.H., and John Z. Ayanian, M.D., M.P.P., in the January 17, 2006, Journal of the American College of Cardiology 47(2), pp. 417-424.

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