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Ioana Popescu, MD, MPH; Brahmajee K. Nallamothu, MD, MPH; Mary S. Vaughan-Sarrazin, PhD; Peter Cram, MD, MBA

Arch Intern Med. 2010;170(14):1209-1215. doi:10.1001/archinternmed.2010.227

Background  Research increasingly shows that blacks with coronary heart disease (CHD) are treated at lower-quality hospitals. Little is known about racial differences in admission to high-quality hospitals.

Methods  We identified all black and white Medicare patients with acute myocardial infarction and coronary artery bypass grafting (CABG) admitted during 2002 through 2005 to hospitals located in markets with top-ranked cardiac hospitals, as ascertained from the US News and World Report "America’s Best Hospitals" annual rankings. The relationship between race and admission to top-ranked hospitals was estimated using multinomial conditional logit models to account for distance from patient residence to all available hospitals.

Results  In unadjusted analyses, blacks with AMI or undergoing CABG, compared with whites, were more likely to be admitted to top-ranked hospitals (18.3% vs 10.5% and 34.4% vs 22.7% [P < .001]) but also more likely to bypass top-ranked hospitals (25.8% vs 14.7% and 37.5% vs 26.3% [P < .001]). In models accounting for distance, blacks with acute myocardial infarction were more likely (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.08-1.16 [P < .001]), whereas blacks undergoing CABG were equally likely (OR, 1.05; 95% CI, 0.97-1.13; P = .27) to be admitted to top-ranked hospitals compared with whites. However, within socially disadvantaged zip codes, blacks undergoing CABG were less likely to receive care at top-ranked hospitals (OR, 0.75; 95% CI, 0.64-0.86 [P < .001]) compared with whites and more likely to bypass top-ranked hospitals located closer to their residence (OR, 1.16; 95% CI, 1.02-1.30 [P = .03]).

Conclusion  Black Medicare patients with acute myocardial infarction or undergoing CABG were equally or more likely to be admitted to top-ranked hospitals, except for socially disadvantaged black patients undergoing CABG.

Author Affiliations: The Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City VA Medical Center, and Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City (Drs Popescu, Vaughan-Sarrazin, and Cram); and The Health Services Research & Development Center of Excellence, Ann Arbor Department of Veterans Affairs Medical Center, Ann Arbor, Michigan (Dr Nallamothu).

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