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Data From the National Hospital Discharge Survey

Wayne H. Giles, MD, MS; Robert F. Anda, MD, MS; Michele L. Casper, PhD; Luis G. Escobedo, MD, MPH; Herman A. Taylor, MD

Arch Intern Med. 1995;155(3):318-324.

Abstract
Background
Lower rates of invasive cardiac procedures have been reported for blacks and women than for white men. However, few studies have adjusted for differences in the type of hospital of admission, insurance status, and disease severity.

Setting, Design, and Participants
Data from the National Hospital Discharge Survey were used to investigate race and sex differences in rates of cardiac catheterization, percutaneous transluminal coronary angioplasty, and coronary artery bypass surgery among 10 348 persons hospitalized for acute myocardial infarction.

Results
White men consistently had the highest procedure rates, followed by white women, black men, and black women. After matching for the hospital of admission and adjusting for age, in-hospital mortality, health insurance, and hospital transfer rates (with white men as the referent), the odds ratios for cardiac catheterization were 0.67 (95% confidence interval [CI],0.51 to 0.87) for black men, 0.72 (95% CI, 0.63 to 0.83) for white women, and 0.50 (95% CI, 0.37 to 0.68) for black women. Similar race-sex differences were noted for percutaneous transluminal coronary angioplasty and coronary artery bypass surgery.

Conclusions
Race and sex differentials in the rates of invasive cardiac procedures remained despite matching for the hospital of admission and controlling for other factors that influence procedure rates, suggesting that the race and sex of the patient influence the use of these procedures.

(Arch Intern Med. 1995;155:318-324)

Author Affiliations
From the Cardiovascular Health Studies Branch, Division of Chronic Disease Control and Community Intervention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Giles, Anda, Casper, and Escobedo); and the Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham (Dr Taylor).

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