Affiliation:
1. Division of General Internal Medicine and Health Services Research David Geffen School of Medicine at UCLA Los Angeles CA
2. RAND Corporation Santa Monica CA
3. University of Minnesota School of Public Health Minneapolis MN
Abstract
Background
Differences in hospital proximity and nongeographic factors affect disparities in hospital quality for heart disease, but their relative contributions are unknown. The current study quantifies the influences of these factors on the white‐black gap in high‐ and low‐quality hospital use for acute myocardial infarction (
AMI
) and coronary artery bypass grafting (
CABG
) surgery.
Methods and Results
We used Medicare claims to identify fee‐for‐service Medicare beneficiaries aged 65 and older hospitalized during 2009–2011 with
AMI
(n=384 443) and
CABG
(n=71 411). Hospital quality was measured using publicly available
AMI
mortality rates. In national and regional analyses, we used conditional multinomial logit models to estimate the white‐black gap in high‐ and low‐quality hospital use and decompose the gap into geographic and nongeographic contributions. Overall, more whites used high‐quality hospitals for both conditions (34.8% versus 32.4% for
AMI
; 39.0% versus 29.9% for
CABG
;
P
<0.001), but after accounting for distance to hospitals, the white‐black gap was significant only for
CABG
(9.1%;
P
<0.001). The nongeographic component was significant for both conditions (3.4% for
AMI
and 7.7% for
CABG
;
P
<0.001) and accounted for nearly the entire gap for
CABG
. In contrast, hospital geographic proximity was not significant. In regional analyses, white beneficiaries had higher rates of high‐quality hospital use in the Northeast (
CABG
) and South (
AMI
and
CABG
), whereas black had higher rates of high‐quality hospital use in the Midwest (
AMI
).
Conclusions
White‐black differences in high‐quality hospital use were significant for
CABG
and related to nongeographic factors. Interventions should consider health system and contextual reasons for these disparities.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
8 articles.
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