Racial disparities in the use of cardiac revascularization: does local hospital capacity matter?

<h4>Objective</h4>To assess the extent to which the observed racial disparities in cardiac revascularization use can be explained by the variation across counties where patients live, and how the within-county racial disparities is associated with the local hospital capacity.<h4>Da...

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Autores principales:	Suhui Li, Arnold Chen, Katherine Mead
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/679b4b06aadb481ab79e8ab48eb6a551
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spelling	oai:doaj.org-article:679b4b06aadb481ab79e8ab48eb6a5512021-11-18T07:37:26ZRacial disparities in the use of cardiac revascularization: does local hospital capacity matter?1932-620310.1371/journal.pone.0069855https://doaj.org/article/679b4b06aadb481ab79e8ab48eb6a5512013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23875005/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Objective</h4>To assess the extent to which the observed racial disparities in cardiac revascularization use can be explained by the variation across counties where patients live, and how the within-county racial disparities is associated with the local hospital capacity.<h4>Data sources</h4>Administrative data from Pennsylvania Health Care Cost Containment Council (PHC4) between 1995 and 2006.<h4>Study design</h4>The study sample included 207,570 Medicare patients admitted to hospital for acute myocardial infarction (AMI). We identified the use of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) procedures within three months after the patient's initial admission for AMI. Multi-level hierarchical models were used to determine the extent to which racial disparities in procedure use were attributable to the variation in local hospital capacity.<h4>Principal findings</h4>Blacks were less likely than whites to receive CABG (9.1% vs. 5.8%; p<0.001) and PCI (15.7% vs. 14.2%; p<0.001). The state-level racial disparity in use rate decreases for CABG, and increases for PCI, with the county adjustment. Higher number of revascularization hospitals per 1,000 AMI patients was associated with smaller within-county racial differences in CABG and PCI rates. Meanwhile, very low capacity of catheterization suites and AMI hospitals contributed to significantly wider racial gap in PCI rate.<h4>Conclusions</h4>County variation in cardiac revascularization use rates helps explain the observed racial disparities. While smaller hospital capacity is associated with lower procedure rates for both racial groups, the impact is found to be larger on blacks. Therefore, consequences of fewer medical resources may be particularly pronounced for blacks, compared with whites.Suhui LiArnold ChenKatherine MeadPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 7, p e69855 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Suhui Li Arnold Chen Katherine Mead Racial disparities in the use of cardiac revascularization: does local hospital capacity matter?
description	<h4>Objective</h4>To assess the extent to which the observed racial disparities in cardiac revascularization use can be explained by the variation across counties where patients live, and how the within-county racial disparities is associated with the local hospital capacity.<h4>Data sources</h4>Administrative data from Pennsylvania Health Care Cost Containment Council (PHC4) between 1995 and 2006.<h4>Study design</h4>The study sample included 207,570 Medicare patients admitted to hospital for acute myocardial infarction (AMI). We identified the use of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) procedures within three months after the patient's initial admission for AMI. Multi-level hierarchical models were used to determine the extent to which racial disparities in procedure use were attributable to the variation in local hospital capacity.<h4>Principal findings</h4>Blacks were less likely than whites to receive CABG (9.1% vs. 5.8%; p<0.001) and PCI (15.7% vs. 14.2%; p<0.001). The state-level racial disparity in use rate decreases for CABG, and increases for PCI, with the county adjustment. Higher number of revascularization hospitals per 1,000 AMI patients was associated with smaller within-county racial differences in CABG and PCI rates. Meanwhile, very low capacity of catheterization suites and AMI hospitals contributed to significantly wider racial gap in PCI rate.<h4>Conclusions</h4>County variation in cardiac revascularization use rates helps explain the observed racial disparities. While smaller hospital capacity is associated with lower procedure rates for both racial groups, the impact is found to be larger on blacks. Therefore, consequences of fewer medical resources may be particularly pronounced for blacks, compared with whites.
format	article
author	Suhui Li Arnold Chen Katherine Mead
author_facet	Suhui Li Arnold Chen Katherine Mead
author_sort	Suhui Li
title	Racial disparities in the use of cardiac revascularization: does local hospital capacity matter?
title_short	Racial disparities in the use of cardiac revascularization: does local hospital capacity matter?
title_full	Racial disparities in the use of cardiac revascularization: does local hospital capacity matter?
title_fullStr	Racial disparities in the use of cardiac revascularization: does local hospital capacity matter?
title_full_unstemmed	Racial disparities in the use of cardiac revascularization: does local hospital capacity matter?
title_sort	racial disparities in the use of cardiac revascularization: does local hospital capacity matter?
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/679b4b06aadb481ab79e8ab48eb6a551
work_keys_str_mv	AT suhuili racialdisparitiesintheuseofcardiacrevascularizationdoeslocalhospitalcapacitymatter AT arnoldchen racialdisparitiesintheuseofcardiacrevascularizationdoeslocalhospitalcapacitymatter AT katherinemead racialdisparitiesintheuseofcardiacrevascularizationdoeslocalhospitalcapacitymatter
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Racial disparities in the use of cardiac revascularization: does local hospital capacity matter?

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