Department of Health Policy, George Washington University, Washington, District of Columbia, United States of America.
PLoS One. 2013 Jul 16;8(7):e69855. doi: 10.1371/journal.pone.0069855. Print 2013.
To assess the extent to which the observed racial disparities in cardiac revascularization use can be explained by the variation across counties where patients live, and how the within-county racial disparities is associated with the local hospital capacity.
Administrative data from Pennsylvania Health Care Cost Containment Council (PHC4) between 1995 and 2006.
The study sample included 207,570 Medicare patients admitted to hospital for acute myocardial infarction (AMI). We identified the use of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) procedures within three months after the patient's initial admission for AMI. Multi-level hierarchical models were used to determine the extent to which racial disparities in procedure use were attributable to the variation in local hospital capacity.
Blacks were less likely than whites to receive CABG (9.1% vs. 5.8%; p<0.001) and PCI (15.7% vs. 14.2%; p<0.001). The state-level racial disparity in use rate decreases for CABG, and increases for PCI, with the county adjustment. Higher number of revascularization hospitals per 1,000 AMI patients was associated with smaller within-county racial differences in CABG and PCI rates. Meanwhile, very low capacity of catheterization suites and AMI hospitals contributed to significantly wider racial gap in PCI rate.
County variation in cardiac revascularization use rates helps explain the observed racial disparities. While smaller hospital capacity is associated with lower procedure rates for both racial groups, the impact is found to be larger on blacks. Therefore, consequences of fewer medical resources may be particularly pronounced for blacks, compared with whites.
评估患者居住地所在县之间的差异在多大程度上可以解释观察到的心脏血运重建术使用方面的种族差异，以及县内种族差异与当地医院能力之间的关系。
1995 年至 2006 年宾夕法尼亚州医疗保健费用控制委员会（PHC4）的行政数据。
研究样本包括 207570 名因急性心肌梗死（AMI）住院的 Medicare 患者。我们确定了患者初次因 AMI 入院后三个月内冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）的使用情况。采用多层次层次模型来确定种族差异在程序使用中的程度归因于当地医院能力的差异。
与白人相比，黑人接受 CABG（9.1%比 5.8%；p<0.001）和 PCI（15.7%比 14.2%；p<0.001）的可能性较小。州一级的 CABG 使用率种族差异随着县一级的调整而降低，而 PCI 的种族差异则增加。每 1000 例 AMI 患者中接受血运重建术的医院数量越多，CABG 和 PCI 率的县内种族差异就越小。同时，导管插入术套房和 AMI 医院的能力极低导致 PCI 率的种族差距显著扩大。
心脏血运重建术使用率的县差异有助于解释观察到的种族差异。虽然较小的医院容量与两个种族群体的手术率较低有关，但对黑人的影响更大。因此，与白人相比，医疗资源较少的后果可能对黑人来说更为明显。
