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. 1998 Jul;88(7):1089–1092. doi: 10.2105/ajph.88.7.1089

Differences in the effect of patients' socioeconomic status on the use of invasive cardiovascular procedures across health insurance categories.

D M Carlisle 1, B D Leake 1
PMCID: PMC1508262  PMID: 9663160

Abstract

OBJECTIVES: This study evaluated the effect of patients' socioeconomic status on use of coronary angiography, bypass grafting, and angioplasty across health insurance categories. METHODS: Multiple logistic regression was used to compute the odds of receiving each procedure among 206 233 ischemic heart disease patients residing in urban California zip codes from 1991 through 1993. RESULTS: Residents of high socioeconomic status areas were more likely (odds ratios [ORs] = 1.20-1.41) and residents of low socioeconomic status areas were less likely (ORs = 0.79-0.84) than residents of middle socioeconomic status areas to undergo each procedure. These effects were common among Medicare and health maintenance organization patients and uncommon for privately insured and uninsured patients. CONCLUSIONS: The effect of socioeconomic status varies across health insurance categories.

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Selected References

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  1. Billings J., Zeitel L., Lukomnik J., Carey T. S., Blank A. E., Newman L. Impact of socioeconomic status on hospital use in New York City. Health Aff (Millwood) 1993 Spring;12(1):162–173. doi: 10.1377/hlthaff.12.1.162. [DOI] [PubMed] [Google Scholar]
  2. Blendon R. J., Donelan K., Hill C. A., Carter W., Beatrice D., Altman D. Paying medical bills in the United States. Why health insurance isn't enough. JAMA. 1994 Mar 23;271(12):949–951. [PubMed] [Google Scholar]
  3. Bombardier C., Fuchs V. R., Lillard L. A., Warner K. E. Socioeconomic factors affecting the utilization of surgical operations. N Engl J Med. 1977 Sep 29;297(13):699–705. doi: 10.1056/NEJM197709292971305. [DOI] [PubMed] [Google Scholar]
  4. Braveman P., Egerter S., Edmonston F., Verdon M. Racial/ethnic differences in the likelihood of cesarean delivery, California. Am J Public Health. 1995 May;85(5):625–630. doi: 10.2105/ajph.85.5.625. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Carlisle D. M., Leake B. D., Shapiro M. F. Racial and ethnic differences in the use of invasive cardiac procedures among cardiac patients in Los Angeles County, 1986 through 1988. Am J Public Health. 1995 Mar;85(3):352–356. doi: 10.2105/ajph.85.3.352. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Carlisle D. M., Leake B. D., Shapiro M. F. Racial and ethnic disparities in the use of cardiovascular procedures: associations with type of health insurance. Am J Public Health. 1997 Feb;87(2):263–267. doi: 10.2105/ajph.87.2.263. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Connell F. A., Diehr P., Hart L. G. The use of large data bases in health care studies. Annu Rev Public Health. 1987;8:51–74. doi: 10.1146/annurev.pu.08.050187.000411. [DOI] [PubMed] [Google Scholar]
  8. Epstein A. M., Stern R. S., Weissman J. S. Do the poor cost more? A multihospital study of patients' socioeconomic status and use of hospital resources. N Engl J Med. 1990 Apr 19;322(16):1122–1128. doi: 10.1056/NEJM199004193221606. [DOI] [PubMed] [Google Scholar]
  9. Feder J., Hadley J., Mullner R. Falling through the cracks: poverty, insurance coverage, and hospital care for the poor, 1980 and 1982. Milbank Mem Fund Q Health Soc. 1984 Fall;62(4):544–566. [PubMed] [Google Scholar]
  10. Gillum R. F. Coronary artery bypass surgery and coronary angiography in the United States, 1979-1983. Am Heart J. 1987 May;113(5):1255–1260. doi: 10.1016/0002-8703(87)90952-5. [DOI] [PubMed] [Google Scholar]
  11. Gornick M. E., Eggers P. W., Reilly T. W., Mentnech R. M., Fitterman L. K., Kucken L. E., Vladeck B. C. Effects of race and income on mortality and use of services among Medicare beneficiaries. N Engl J Med. 1996 Sep 12;335(11):791–799. doi: 10.1056/NEJM199609123351106. [DOI] [PubMed] [Google Scholar]
  12. Gould J. B., Davey B., Stafford R. S. Socioeconomic differences in rates of cesarean section. N Engl J Med. 1989 Jul 27;321(4):233–239. doi: 10.1056/NEJM198907273210406. [DOI] [PubMed] [Google Scholar]
  13. Hayward R. A., Shapiro M. F., Freeman H. E., Corey C. R. Inequities in health services among insured Americans. Do working-age adults have less access to medical care than the elderly? N Engl J Med. 1988 Jun 9;318(23):1507–1512. doi: 10.1056/NEJM198806093182305. [DOI] [PubMed] [Google Scholar]
  14. Langa K. M., Sussman E. J. The effect of cost-containment policies on rates of coronary revascularization in California. N Engl J Med. 1993 Dec 9;329(24):1784–1789. doi: 10.1056/NEJM199312093292407. [DOI] [PubMed] [Google Scholar]
  15. Morrison E. M., Luft H. S. Health maintenance organization environments in the 1980s and beyond. Health Care Financ Rev. 1990 Fall;12(1):81–90. [PMC free article] [PubMed] [Google Scholar]
  16. Nolan R. L., Schwartz J. L., Simonian K. Social class differences in utilization of pediatric services in a prepaid direct service medical care program. Am J Public Health Nations Health. 1967 Jan;57(1):34–47. doi: 10.2105/ajph.57.1.34. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Payne N., Saul C. Variations in use of cardiology services in a health authority: comparison of coronary artery revascularisation rates with prevalence of angina and coronary mortality. BMJ. 1997 Jan 25;314(7076):257–261. doi: 10.1136/bmj.314.7076.257. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Peterson E. D., Wright S. M., Daley J., Thibault G. E. Racial variation in cardiac procedure use and survival following acute myocardial infarction in the Department of Veterans Affairs. JAMA. 1994 Apr 20;271(15):1175–1180. [PubMed] [Google Scholar]
  19. Tessler R., Mechanic D. Consumer satisfaction with prepaid group practice: a comparative study. J Health Soc Behav. 1975 Mar;16(1):95–113. [PubMed] [Google Scholar]
  20. Tokarski C. Two studies, one conclusion: employer health insurance eroding. J Am Health Policy. 1994 Jul-Aug;4(4):21–21. [PubMed] [Google Scholar]
  21. Ware J. E., Jr, Bayliss M. S., Rogers W. H., Kosinski M., Tarlov A. R. Differences in 4-year health outcomes for elderly and poor, chronically ill patients treated in HMO and fee-for-service systems. Results from the Medical Outcomes Study. JAMA. 1996 Oct 2;276(13):1039–1047. [PubMed] [Google Scholar]
  22. Ware J. E., Jr, Brook R. H., Rogers W. H., Keeler E. B., Davies A. R., Sherbourne C. D., Goldberg G. A., Camp P., Newhouse J. P. Comparison of health outcomes at a health maintenance organisation with those of fee-for-service care. Lancet. 1986 May 3;1(8488):1017–1022. doi: 10.1016/s0140-6736(86)91282-1. [DOI] [PubMed] [Google Scholar]
  23. Wenneker M. B., Weissman J. S., Epstein A. M. The association of payer with utilization of cardiac procedures in Massachusetts. JAMA. 1990 Sep 12;264(10):1255–1260. [PubMed] [Google Scholar]
  24. Yergan J., Flood A. B., Diehr P., LoGerfo J. P. Relationship between patient source of payment and the intensity of hospital services. Med Care. 1988 Nov;26(11):1111–1114. doi: 10.1097/00005650-198811000-00009. [DOI] [PubMed] [Google Scholar]

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