Background -Few studies have examined the association of race and outcomes after coronary artery bypass graft(CABG)surgery while controlling for both patient and hospital effects. Methods and Results -We retrospective...Background -Few studies have examined the association of race and outcomes after coronary artery bypass graft(CABG)surgery while controlling for both patient and hospital effects. Methods and Results -We retrospectively analyzed data on a cohort of 566 785 white and 24 354 black Medicare beneficiaries 65 years old and older undergoing CABG in 1091 US hospitals from 1997 to 2000. Mortality and repeat revascularization rates were examined after sequential adjustment for patient and hospital differences by use of generalized estimating equations. Unadjusted mortality was higher(P< 0.001) in black than in white patients at 30(6.4%versus 5.2%), 90(8.3%versus 6.6%), and 365 days(13.5%versus 9.8%) after surgery. Black patients were more likely(P< 0.001) to undergo CABG at hospitals with the highest mortality(56%versus 47%) and at hospitals in the lowest volume quintile(24%versus 20%). Adjusted only for patient characteristics, mortality was 8%, 11%, and 25%higher in black patients at 30, 90, and 365 days. After adjustment for hospital effects, 30 and 90 day mortality was similar but 17%higher in black patients at 365 days. Racial differences in mortality were greater in men than in women. On adjustment for patient and hospital effects, repeat revascularization rates were similar in black and white patients. Conclusions -Racial disparities in CABG outcomes are sensitive to the effects of sex and duration of postsurgical follow-up. The increasing disparity in outcomes as follow-up increased is consistent with the hypothesis that black patients have less access to secondary prevention and rehabilitation services after surgery.展开更多
Background -Although public release of quality information through report cards is intended to improve health care, there may be unintended consequences of report cards, such as physicians avoiding high-risk patients ...Background -Although public release of quality information through report cards is intended to improve health care, there may be unintended consequences of report cards, such as physicians avoiding high-risk patients to improve their ratings. If physicians believe that racial and ethnic minorities are at higher risk for poor outcomes, report cards could worsen existing racial and ethnic disparities in health care. Methods and Results -To investigate the impact of New York’s CABG report card on racial and ethnic disparities in cardiac care, we estimated differences in the use of CABG, PTCA, and cardiac catheterization between white versus black and Hispanic patients hospitalized for acute myocardial infarction in New York before and after New York’s first CABG report card was released, adjusting for patient and hospital characteristics and national changes in racial and ethnic disparities in cardiac care. The racial and ethnic disparity in CABG use significantly increased in New York immediately after New York’s CABG report card was released, whereas disparities did not change significantly in the comparison states. There was no differential change in racial and ethnic disparities between New York and the comparison states in the use of cardiac catheterization or PTCA after the CABG report card was released. Over time, this increase in racial and ethnic disparities decreased to levels similar to those before the release of report cards. Conclusions -The release of CABG report cards in New York was associated with a widening of the disparity in CABG use between white versus black and Hispanic patients.展开更多
文摘Background -Few studies have examined the association of race and outcomes after coronary artery bypass graft(CABG)surgery while controlling for both patient and hospital effects. Methods and Results -We retrospectively analyzed data on a cohort of 566 785 white and 24 354 black Medicare beneficiaries 65 years old and older undergoing CABG in 1091 US hospitals from 1997 to 2000. Mortality and repeat revascularization rates were examined after sequential adjustment for patient and hospital differences by use of generalized estimating equations. Unadjusted mortality was higher(P< 0.001) in black than in white patients at 30(6.4%versus 5.2%), 90(8.3%versus 6.6%), and 365 days(13.5%versus 9.8%) after surgery. Black patients were more likely(P< 0.001) to undergo CABG at hospitals with the highest mortality(56%versus 47%) and at hospitals in the lowest volume quintile(24%versus 20%). Adjusted only for patient characteristics, mortality was 8%, 11%, and 25%higher in black patients at 30, 90, and 365 days. After adjustment for hospital effects, 30 and 90 day mortality was similar but 17%higher in black patients at 365 days. Racial differences in mortality were greater in men than in women. On adjustment for patient and hospital effects, repeat revascularization rates were similar in black and white patients. Conclusions -Racial disparities in CABG outcomes are sensitive to the effects of sex and duration of postsurgical follow-up. The increasing disparity in outcomes as follow-up increased is consistent with the hypothesis that black patients have less access to secondary prevention and rehabilitation services after surgery.
文摘Background -Although public release of quality information through report cards is intended to improve health care, there may be unintended consequences of report cards, such as physicians avoiding high-risk patients to improve their ratings. If physicians believe that racial and ethnic minorities are at higher risk for poor outcomes, report cards could worsen existing racial and ethnic disparities in health care. Methods and Results -To investigate the impact of New York’s CABG report card on racial and ethnic disparities in cardiac care, we estimated differences in the use of CABG, PTCA, and cardiac catheterization between white versus black and Hispanic patients hospitalized for acute myocardial infarction in New York before and after New York’s first CABG report card was released, adjusting for patient and hospital characteristics and national changes in racial and ethnic disparities in cardiac care. The racial and ethnic disparity in CABG use significantly increased in New York immediately after New York’s CABG report card was released, whereas disparities did not change significantly in the comparison states. There was no differential change in racial and ethnic disparities between New York and the comparison states in the use of cardiac catheterization or PTCA after the CABG report card was released. Over time, this increase in racial and ethnic disparities decreased to levels similar to those before the release of report cards. Conclusions -The release of CABG report cards in New York was associated with a widening of the disparity in CABG use between white versus black and Hispanic patients.
