Skip to main content
NCBI home page
American Journal of Public Health logoLink to American Journal of Public Health
. 1995 Mar;85(3):345–351. doi: 10.2105/ajph.85.3.345

Access to hospitals with high-technology cardiac services: how is race important?

J Blustein 1, B C Weitzman 1
PMCID: PMC1614869  PMID: 7892917

Abstract

OBJECTIVES. Relatively few hospitals in the United States offer high-technology cardiac services (cardiac catheterization, bypass surgery, or angioplasty). This study examined the association between race and admission to a hospital offering those services. METHODS. Records of 11,410 patients admitted with acute myocardial infarction to hospitals in New York State in 1986 were analyzed. RESULTS. Approximately one third of both White and Black patients presented to hospitals offering high-technology cardiac services. However, in a multivariate model adjusting for home-to-hospital distance, the White-to-Black odds ratio for likelihood of presentation to such a hospital was 1.68 (95% confidence interval = 1.42, 1.98). This discrepancy between the observed and "distance-adjusted" probabilities reflected three phenomena: (1) patients presented to nearby hospitals; (2) Blacks were more likely to live near high-technology hospitals; and (3) there were racial differences in travel patterns. For example, when the nearest hospitals did not include a high-technology hospital, Whites were more likely than Blacks to travel beyond those nearest hospitals to a high-technology hospital. CONCLUSIONS. Whites and Blacks present equally to hospitals offering high-technology cardiac services at the time of acute myocardial infarction. However, there are important underlying racial differences in geographic proximity and tendencies to travel to those hospitals.

Full text

PDF
345

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aday L. A., Andersen R. M. The national profile of access to medical care: where do we stand? Am J Public Health. 1984 Dec;74(12):1331–1339. doi: 10.2105/ajph.74.12.1331. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Alemi F., Rice J., Hankins R. Predicting in-hospital survival of myocardial infarction. A comparative study of various severity measures. Med Care. 1990 Sep;28(9):762–775. doi: 10.1097/00005650-199009000-00006. [DOI] [PubMed] [Google Scholar]
  3. Ayanian J. Z., Udvarhelyi I. S., Gatsonis C. A., Pashos C. L., Epstein A. M. Racial differences in the use of revascularization procedures after coronary angiography. JAMA. 1993 May 26;269(20):2642–2646. [PubMed] [Google Scholar]
  4. Becker L. B., Han B. H., Meyer P. M., Wright F. A., Rhodes K. V., Smith D. W., Barrett J. Racial differences in the incidence of cardiac arrest and subsequent survival. The CPR Chicago Project. N Engl J Med. 1993 Aug 26;329(9):600–606. doi: 10.1056/NEJM199308263290902. [DOI] [PubMed] [Google Scholar]
  5. Blustein J. High-technology cardiac procedures. The impact of service availability on service use in New York State. JAMA. 1993 Jul 21;270(3):344–349. doi: 10.1001/jama.270.3.344. [DOI] [PubMed] [Google Scholar]
  6. Blustein J. The reliability of racial classifications in hospital discharge abstract data. Am J Public Health. 1994 Jun;84(6):1018–1021. doi: 10.2105/ajph.84.6.1018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Bronstein J. M., Morrisey M. A. Determinants of rural travel distance for obstetrics care. Med Care. 1990 Sep;28(9):853–865. doi: 10.1097/00005650-199009000-00013. [DOI] [PubMed] [Google Scholar]
  8. Cowie M. R., Fahrenbruch C. E., Cobb L. A., Hallstrom A. P. Out-of-hospital cardiac arrest: racial differences in outcome in Seattle. Am J Public Health. 1993 Jul;83(7):955–959. doi: 10.2105/ajph.83.7.955. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Dranove D., White W. D., Wu L. Segmentation in local hospital markets. Med Care. 1993 Jan;31(1):52–64. doi: 10.1097/00005650-199301000-00004. [DOI] [PubMed] [Google Scholar]
  10. Every N. R., Larson E. B., Litwin P. E., Maynard C., Fihn S. D., Eisenberg M. S., Hallstrom A. P., Martin J. S., Weaver W. D. The association between on-site cardiac catheterization facilities and the use of coronary angiography after acute myocardial infarction. Myocardial Infarction Triage and Intervention Project Investigators. N Engl J Med. 1993 Aug 19;329(8):546–551. doi: 10.1056/NEJM199308193290807. [DOI] [PubMed] [Google Scholar]
  11. Gold M., Greenlick M. Effect of hospital-based primary care setting on internists' use of inpatient hospital resources. Med Care. 1981 Feb;19(2):160–171. doi: 10.1097/00005650-198102000-00004. [DOI] [PubMed] [Google Scholar]
  12. Goldberg K. C., Hartz A. J., Jacobsen S. J., Krakauer H., Rimm A. A. Racial and community factors influencing coronary artery bypass graft surgery rates for all 1986 Medicare patients. JAMA. 1992 Mar 18;267(11):1473–1477. [PubMed] [Google Scholar]
  13. Hannan E. L., Kilburn H., Jr, O'Donnell J. F., Lukacik G., Shields E. P. Interracial access to selected cardiac procedures for patients hospitalized with coronary artery disease in New York State. Med Care. 1991 May;29(5):430–441. doi: 10.1097/00005650-199105000-00004. [DOI] [PubMed] [Google Scholar]
  14. Iezzoni L. I., Burnside S., Sickles L., Moskowitz M. A., Sawitz E., Levine P. A. Coding of acute myocardial infarction. Clinical and policy implications. Ann Intern Med. 1988 Nov 1;109(9):745–751. doi: 10.7326/0003-4819-109-9-745. [DOI] [PubMed] [Google Scholar]
  15. Johnson P. A., Lee T. H., Cook E. F., Rouan G. W., Goldman L. Effect of race on the presentation and management of patients with acute chest pain. Ann Intern Med. 1993 Apr 15;118(8):593–601. doi: 10.7326/0003-4819-118-8-199304150-00004. [DOI] [PubMed] [Google Scholar]
  16. Mayer J. D. The distance behavior of hospital patients: a disaggregated analysis. Soc Sci Med. 1983;17(12):819–827. doi: 10.1016/0277-9536(83)90032-1. [DOI] [PubMed] [Google Scholar]
  17. Maynard C., Fisher L. D., Passamani E. R., Pullum T. Blacks in the Coronary Artery Surgery Study: risk factors and coronary artery disease. Circulation. 1986 Jul;74(1):64–71. doi: 10.1161/01.cir.74.1.64. [DOI] [PubMed] [Google Scholar]
  18. Maynard C., Litwin P. E., Martin J. S., Cerqueira M., Kudenchuk P. J., Ho M. T., Kennedy J. W., Cobb L. A., Schaeffer S. M., Hallstrom A. P. Characteristics of black patients admitted to coronary care units in metropolitan Seattle: results from the Myocardial Infarction Triage and Intervention Registry (MITI). Am J Cardiol. 1991 Jan 1;67(1):18–23. doi: 10.1016/0002-9149(91)90092-y. [DOI] [PubMed] [Google Scholar]
  19. McGuirk M. A., Porell F. W. Spatial patterns of hospital utilization: the impact of distance and time. Inquiry. 1984 Spring;21(1):84–95. [PubMed] [Google Scholar]
  20. Tofler G. H., Stone P. H., Muller J. E., Willich S. N., Davis V. G., Poole W. K., Strauss H. W., Willerson J. T., Jaffe A. S., Robertson T. Effects of gender and race on prognosis after myocardial infarction: adverse prognosis for women, particularly black women. J Am Coll Cardiol. 1987 Mar;9(3):473–482. doi: 10.1016/s0735-1097(87)80038-4. [DOI] [PubMed] [Google Scholar]
  21. Wennberg J. E. Dealing with medical practice variations: a proposal for action. Health Aff (Millwood) 1984 Summer;3(2):6–32. doi: 10.1377/hlthaff.3.2.6. [DOI] [PubMed] [Google Scholar]
  22. Wenneker M. B., Epstein A. M. Racial inequalities in the use of procedures for patients with ischemic heart disease in Massachusetts. JAMA. 1989 Jan 13;261(2):253–257. [PubMed] [Google Scholar]
  23. Whittle J., Conigliaro J., Good C. B., Lofgren R. P. Racial differences in the use of invasive cardiovascular procedures in the Department of Veterans Affairs medical system. N Engl J Med. 1993 Aug 26;329(9):621–627. doi: 10.1056/NEJM199308263290907. [DOI] [PubMed] [Google Scholar]
  24. Young W. W., Swinkola R. B., Zorn D. M. The measurement of hospital case mix. Med Care. 1982 May;20(5):501–512. doi: 10.1097/00005650-198205000-00006. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES