Mirvis D M, Burns R, Gaschen L, Cloar F T, Graney M
Department of Veterans Affairs Medical Center, Memphis, Tennessee.
J Am Coll Cardiol. 1994 Nov 1;24(5):1297-304. doi: 10.1016/0735-1097(94)90112-0.
Utilization rates for cardiac catheterization and cardiac surgery in the Department of Veterans Affairs (VA) health care system were studied to determine whether racial differences existed in a delivery plan in which access is not determined by patient finances.
Prior studies have demonstrated significant differences in utilization of cardiac diagnostic and therapeutic resources by white and black patients. Reasons for the reduced utilization by black patients include socioeconomic, biologic and sociocultural effects.
Computerized discharge records of 30,300 patients with coronary artery disease and 1,335 patients with valvular heart disease who were discharged from any of 172 VA Medical Centers between October 1, 1990 and September 30, 1991 were studied.
For patients with coronary artery disease, utilization rates of cardiac catheterization were significantly greater for white patients (503.4 procedures/1,000 patients) than for black patients (433.2/1,000 patients), with a relative odds ratio of 1.33. Rates for surgery (179.0 vs. 124.5/1,000 patients) were also greater for whites than for blacks, with a relative odds ratio of 1.53. For the subset with valve disease, the catheterization rate was significantly greater for whites than for blacks (575.4 vs. 432.6 procedures/1,000 patients), with a relative odds ratio of 1.78. Surgical rates were not significantly different (423.8 vs. 354.6 operations/1,000 patients). Racial differences for both catheterization and surgery varied widely as a function of geographic region and the level of complexity of the local VA facility.
Racial differences in resource utilization exist in a health care system in which economic influences are minimized. The pattern of these differences depends on numerous variables and suggests both biologic and sociocultural factors as underlying causes.
研究美国退伍军人事务部（VA）医疗保健系统中心脏导管插入术和心脏手术的利用率，以确定在一个获取医疗服务不由患者经济状况决定的医疗计划中是否存在种族差异。
先前的研究表明，白人和黑人患者在心脏诊断和治疗资源的利用上存在显著差异。黑人患者利用率降低的原因包括社会经济、生物学和社会文化影响。
研究了1990年10月1日至1991年9月30日期间从172家VA医疗中心中的任何一家出院的30300例冠心病患者和1335例瓣膜性心脏病患者的计算机化出院记录。
对于冠心病患者，白人患者心脏导管插入术的利用率（503.4例/1000例患者）显著高于黑人患者（433.2/1000例患者），相对优势比为1.33。白人患者的手术率（179.0例/1000例患者对124.5/1000例患者）也高于黑人患者，相对优势比为1.53。对于瓣膜病亚组，白人患者的导管插入率显著高于黑人患者（575.4例/1000例患者对432.6例/1000例患者），相对优势比为1.78。手术率无显著差异（423.8例手术/1000例患者对354.6例手术/1000例患者）。导管插入术和手术的种族差异因地理区域和当地VA设施的复杂程度而异。
在一个经济影响最小化的医疗保健系统中，存在资源利用方面的种族差异。这些差异的模式取决于众多变量，提示生物学和社会文化因素均为潜在原因。
