Race, gender, and cardiovascular disease: do disparities exist at hospitals that serve majority black populations when patients present with ischemic heart disease and myocardial infarction?

Abstract: A retrospective review of data was conducted to determine whether disparities in cardiovascular disease treatment occurred in three public teaching hospitals in Louisiana when patients presented for care with ischemic heart disease (IHD) or acute myocardial infarction (MI). Multinomial logit models were used to estimate the adjusted odds in the utilization of invasive procedures, while controlling for confounders (i.e., age, marital status, comorbidities, payer type, diabetes, and cigarette addiction) simultaneously. No significant racial disparities were found for cardiac catheterization (CC) or Percutaneous Transluminal Coronary Angioplasty (PTCA). However, Blacks had a lower adjusted odds ratio (p Key Words: Cardiovascular Disease, Disparities, Race, Gender, Ischemic Heart Disease, and Myocardial Infarction Researchers have documented disparities in cardiovascular disease (CVD) invasive procedures (Ayanian & Epstein, 1991; Brown, 2002; Caillier, Brown, Parsons, Ardoin, & Cruise, 2004; Carlisle, Leake, & Shapiro, 1997; Giles, Anda, Casper, Escobedo, & Taylor, 1995; Gittelsohn, Halpern, & Sanchez, 1991; Goldberg, Hartz, & Jacobsen, 1992; Hannan, Kilburn, & O'Donnell, 1991; Hannan, Van Ryn, & Burke, 1999; Kressin & Peterson, 2001; Laouri et al., 1997; Peterson, Wright, Peterson, & Daley, 2002; Schneider et al., 2001; Udvarhelyi et al., 1992; Watson et al., 2001; Wenneker & Epstein, 1989). They have found that Black patients are less likely to undergo invasive cardiac procedures when compared to Whites ( Kressin & Peterson, 2001; Peterson, Wright, Daley, & Thibault, 1994; Schneider et al., 2001; Wenneker & Epstein, 1989). Researchers have also found that females are less likely to undergo invasive cardiac procedures than males (Gordon, Harper, & Rosenthal, 1996; Lincoff et al., 1993; Vaccarino, Parsons, Every, Barron, & Krumholz, 1999). These disparities were found after controlling for age, socioeconomic status, payer type, disease severity, and access to care (Whittle, Conigliaro, Good, & Lofgren, 1993). However, one study round that these disparities diminished when only patients with ischemic heart disease (IHD) and acute myocardial infarction (MI) were examined (Ferguson et al., 1997). Studies that have examined racial and gender differences in CVD treatment have at least one limitation. These studies were conducted at hospitals, clinics, or systems that serve small percentages of Black patients. It is possible that racial disparities are lower at hospitals that serve a majority of Black patients. Therefore, this study was conducted to examine the effects of race and gender on cardiac procedure utilization at three hospitals that serve mostly Black patient populations. This study also built upon the research conducted by Ferguson et al. (1997) by only including patients diagnosed with IHD and MI. It was hypothesized that Black and female patients who presented with IHD and MI would be as likely to utilize CVD invasive procedures when compared to Whites and males. METHOD Settings To determine the effects of race and gender on IHD and MI invasive treatment, data were obtained from a Shared Medical Systems (SMS) financial database used by the three urban public health hospitals in the State of Louisiana. The hospitals are located in metropolitan areas and service both rural and urban patients in the southeastern part of the state. They are also teaching hospitals that encompass professional schools of medicine, nursing, and dentistry as well as other allied health professions. …