Ethnic Disparities Between Blacks and Whites Receiving Cardiac Procedures Eliminated

In a seven-year national study, white patients with chronic renal failure were three times more likely to receive cardiac catheterization, angioplasty, and coronary artery bypass surgery than were their black counterparts, according to researchers at the Johns Hopkins School of Public Health. This large ethnic disparity narrowed greatly, however, once blacks developed end-stage renal disease (ESRD), which made them eligible to receive comprehensive medical care through Medicare. The study was published in the February 2, 1999, issue of The Annals of Internal Medicine.

Lead author Gail L. Daumit, MD, senior fellow, the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Schools of Public Health and Medicine, said, "The study suggests that when patients have adequate health insurance, a regular source of care, and a strong clinical indication for a cardiac procedure, equity in use of services among blacks and whites can be achieved."

During 1986-1987, the scientists enlisted a random sample of 4,987 adults (1,835 black and 3,152 white patients) with chronic renal disease from 303 dialysis facilities across the nation. Patients with chronic renal disease were studied because they are at high risk for cardiovascular disease and, with the onset of ESRD, they almost always become eligible for Medicare and comprehensive health care. The patients were followed for up to seven years--until death, renal transplant, or the end of the study on 12/31/92--while the researchers recorded if and when coronary catheterization, angioplasty, or bypass surgery was received.

Prior to developing ESRD and starting dialysis, whites were more than three times as likely as blacks to have received a cardiac therapeutic procedure (catheterization, angioplasty, orcoronary bypass surgery), even after accounting for factors such as education, employment, age, and medical history. After onset of ESRD, however, whites were only 1.4 times more likely than blacks to receive a cardiac procedure. In those patients receiving Medicare before onset of

ESRD, and in those admitted to the hospital for a heart attack, the initial three-fold difference in procedure use was eliminated.

Senior author Neil R. Powe, MD, MPH, professor, Epidemiology and Health Policy and Management, and director, The Welch Center, Johns Hopkins School of Public Health, said, "This study shows that the U.S. health care system is capable of eliminating ethnic disparities in health care under the right circumstances. We need to learn how to make this happen under all circumstances so that all Americans can benefit from health care technology."

Although coronary heart disease deaths have decreased significantly since the 1980s due to cardiac catheterization, angioplasty, and bypass surgery, African Americans' rates of cardiac mortality and of invasive cardiac procedures continue to compare unfavorably to those of whites.

Support for this study was provided by the Robert Wood Johnson Foundation; the National Institute for Diabetes and Digestive and Kidney Diseases at the National Institutes of Health (NIH); and the National Heart, Lung, and Blood Institute (NIH).