Franks A L, May D S, Wenger N K, Blount S B, Eaker E D
Office of Surveillance and Analysis, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724.
Ethn Dis. 1993 Summer;3(3):213-20.
We examined differences in the use of invasive diagnostic and therapeutic coronary procedures between white and black Medicare beneficiaries following acute myocardial infarction. We used Medicare hospitalization data for patients aged 65 years or older who were hospitalized with an acute myocardial infarction in 1988, and we followed them through the calendar year to determine whether they received invasive coronary procedures. We used multivariate logistic regression to control simultaneously for multiple potential confounding factors including age, geographic region, poverty, comorbid conditions, access to hospitals equipped to provide invasive procedures, and short-term survival. We calculated odds ratios for racial differences in use of invasive diagnostic procedures (coronary arteriography, cardiac catheterization) and, separately, of myocardial revascularization procedures (coronary artery bypass grafting, percutaneous transluminal coronary angioplasty). We found that the odds of receiving an invasive diagnostic procedure after acute myocardial infarction were 2.0 times greater for white men than for black men (95% CI: 1.8-2.1); for white women, the odds were 1.5 times greater than for black women (95% CI: 1.4-1.6). Following an invasive diagnostic procedure, the odds of myocardial revascularization were 1.8 times greater among white than among black men (95% CI: 1.6-2.0), and 1.7 times greater among white than among black women (95% CI: 1.6-2.0). We conclude that invasive diagnostic and therapeutic coronary procedures are used more often among white than among black Medicare beneficiaries following acute myocardial infarction. Further investigation of this discrepancy will require detailed clinical and attitudinal information from medical records, patients, and physicians.
我们研究了急性心肌梗死后白人和黑人医疗保险受益人群在侵入性冠状动脉诊断和治疗程序使用方面的差异。我们使用了1988年因急性心肌梗死住院的65岁及以上患者的医疗保险住院数据，并在整个日历年跟踪他们，以确定他们是否接受了侵入性冠状动脉程序。我们使用多变量逻辑回归同时控制多个潜在的混杂因素，包括年龄、地理区域、贫困、合并症、是否能进入配备提供侵入性程序的医院以及短期生存率。我们计算了侵入性诊断程序（冠状动脉造影、心导管插入术）使用方面种族差异的比值比，以及单独计算心肌血运重建程序（冠状动脉旁路移植术、经皮腔内冠状动脉成形术）使用方面种族差异的比值比。我们发现，急性心肌梗死后接受侵入性诊断程序的几率，白人男性比黑人男性高2.0倍（95%置信区间：1.8 - 2.1）；白人女性比黑人女性高1.5倍（95%置信区间：1.4 - 1.6）。在接受侵入性诊断程序后，白人男性进行心肌血运重建的几率比黑人男性高1.8倍（95%置信区间：1.6 - 2.0），白人女性比黑人女性高1.7倍（95%置信区间：1.6 - 2.0）。我们得出结论，急性心肌梗死后，白人医疗保险受益人群比黑人医疗保险受益人群更常使用侵入性冠状动脉诊断和治疗程序。对此差异进行进一步调查将需要从医疗记录、患者和医生处获取详细的临床和态度信息。
