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Racial variation in the use of coronary-revascularization procedures. Are the differences real? Do they matter?

Publication ,  Journal Article
Peterson, ED; Shaw, LK; DeLong, ER; Pryor, DB; Califf, RM; Mark, DB
Published in: N Engl J Med
February 13, 1997

BACKGROUND: Studies have reported that blacks undergo fewer coronary-revascularization procedures than whites, but it is not clear whether the clinical characteristics of the patients account for these differences or whether they indicate underuse of the procedures in blacks or overuse in whites. METHODS: In a study at Duke University of 12,402 patients (10.3 percent of whom were black) with coronary disease, we calculated unadjusted and adjusted rates of angioplasty and bypass surgery in blacks and whites after cardiac catheterization. We also examined patterns of treatment after stratifying the patients according to the severity of disease, angina status, and estimated survival benefit due to revascularization. Finally, we compared five-year survival rates in blacks and whites. RESULTS: After adjustment for the severity of disease and other characteristics, blacks were 13 percent less likely than whites to undergo angioplasty and 32 percent less likely to undergo bypass surgery. The adjusted black:white odds ratios for receiving these procedures were 0.87 (95 percent confidence interval, 0.73 to 1.03) and 0.68 (95 percent confidence interval, 0.56 to 0.82), respectively. The racial differences in rates of bypass surgery persisted among those with severe anginal symptoms (31 percent of blacks underwent surgery, vs. 45 percent of whites, P<0.001) and among those predicted to have the greatest survival benefit from revascularization (42 percent vs. 61 percent, P<0.001). Finally, unadjusted and adjusted rates of survival for five years were significantly lower in blacks than in whites. CONCLUSIONS: Blacks with coronary disease were significantly less likely than whites to undergo coronary revascularization, particularly bypass surgery - a difference that could not be explained by the clinical features of their disease. The differences in treatment were most pronounced among those predicted to benefit the most from revascularization. Since these differences also correlated with a lower survival rate in blacks, we conclude that coronary revascularization appears to be underused in blacks.

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Published In

N Engl J Med

DOI

ISSN

0028-4793

Publication Date

February 13, 1997

Volume

336

Issue

7

Start / End Page

480 / 486

Location

United States

Related Subject Headings

  • White People
  • Survival Rate
  • Prognosis
  • Practice Patterns, Physicians'
  • Patient Selection
  • North Carolina
  • Logistic Models
  • Humans
  • Hospitals, University
  • General & Internal Medicine
 

Citation

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ICMJE
MLA
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Peterson, E. D., Shaw, L. K., DeLong, E. R., Pryor, D. B., Califf, R. M., & Mark, D. B. (1997). Racial variation in the use of coronary-revascularization procedures. Are the differences real? Do they matter? N Engl J Med, 336(7), 480–486. https://doi.org/10.1056/NEJM199702133360706
Peterson, E. D., L. K. Shaw, E. R. DeLong, D. B. Pryor, R. M. Califf, and D. B. Mark. “Racial variation in the use of coronary-revascularization procedures. Are the differences real? Do they matter?N Engl J Med 336, no. 7 (February 13, 1997): 480–86. https://doi.org/10.1056/NEJM199702133360706.
Peterson ED, Shaw LK, DeLong ER, Pryor DB, Califf RM, Mark DB. Racial variation in the use of coronary-revascularization procedures. Are the differences real? Do they matter? N Engl J Med. 1997 Feb 13;336(7):480–6.
Peterson, E. D., et al. “Racial variation in the use of coronary-revascularization procedures. Are the differences real? Do they matter?N Engl J Med, vol. 336, no. 7, Feb. 1997, pp. 480–86. Pubmed, doi:10.1056/NEJM199702133360706.
Peterson ED, Shaw LK, DeLong ER, Pryor DB, Califf RM, Mark DB. Racial variation in the use of coronary-revascularization procedures. Are the differences real? Do they matter? N Engl J Med. 1997 Feb 13;336(7):480–486.
Journal cover image

Published In

N Engl J Med

DOI

ISSN

0028-4793

Publication Date

February 13, 1997

Volume

336

Issue

7

Start / End Page

480 / 486

Location

United States

Related Subject Headings

  • White People
  • Survival Rate
  • Prognosis
  • Practice Patterns, Physicians'
  • Patient Selection
  • North Carolina
  • Logistic Models
  • Humans
  • Hospitals, University
  • General & Internal Medicine