June 13, 2007
Photo: Ioana Popescu, M.D., health services research investigator at the VA Iowa City Health Care System and an associate in internal medicine at the UI Roy J. and Lucille A. Carver College of Medicine.
Black Medicare Patients Less Likely To Get Certain Heart Attack Treatments
A new study from the University of Iowa and Department of Veterans Affairs (VA) reveals that black Medicare patients who have had heart attacks are less likely than white patients to receive heart bypass surgery or angioplasty even after being admitted to hospitals that provide the services.
The study also found that although black patients, as compared to white patients, were less likely to die within the first 30 days after a heart attack, they were more likely to die thereafter. The findings, which were based on Medicare data for patients age 68 and older, appear in the June 13 issue of the Journal of the American Medical Association.
"While differences in heart attack treatments for black and white patients have been well known for some time, less is known about where and when in the process these differences arise. We looked at patterns of care by hospital type, which has not been previously explored in detail," said the study's lead author, Ioana Popescu, M.D., a health services research investigator at the VA Iowa City Health Care System and an associate in internal medicine at the UI Roy J. and Lucille A. Carver College of Medicine.
"The fact that black patients were less likely to receive specialized heart care services even when transferred to hospitals that do provide these services suggests that the difference is not simply one of access to life-saving treatments but that some other factors, likely a combination, are at play," she added.
The team examined the insurance records of more than 1.2 million black and white Medicare beneficiaries age 68 and older who had heart attacks and were admitted between 2000 and 2005 to hospitals that do provide angioplasty (using a ballooning device to open blocked arteries) and heart bypass surgery, and patients who were admitted to hospitals that do not provide these services. The study included 4,627 hospitals overall.
The investigators found that when it came to transferring patients who had heart attacks from hospitals without specialized heart care services to hospitals with such services, slightly more than 25 percent of black patients, compared to 31 percents of whites, were transferred.
In addition, while 50 percent of white patients admitted to hospitals with specialized heart care services received a bypass or angioplasty, only 34 percent of black patients admitted to such hospitals did. Similarly, nearly 26 percent of whites received specialized treatments if first admitted to hospitals without such services, compared to slightly more than 18 percent of black patients initially admitted to such hospitals after a heart attack.
Black patients admitted to hospitals without specialized heart care services had a lower death rate within the first 30 days after a heart attack -- 19.6 percent of black patients died as compared to 20.4 percent of white patients. However, the death rates for black patients admitted at these hospitals was higher one year after heart attacks -- 39.8 percent for blacks compared to 37.6 percent for white patients.
The researchers said it is not clear why all these differences occur but possibilities for study include socioeconomic factors, the way the symptoms of patients present when they come to the hospital, patient preferences for different types of treatments, and the medical decision-making process.
"What we were able to show is that the differences in post-heart attack treatment do not seem to be related to access to a certain type of service, because no matter what type of hospital black Medicare patients were admitted to, compared to white patients, they were less likely to receive these treatments. I think it's important that people realize it's not a matter of where you go; it's what happens once you're there," Popescu said.
The study was supported in part by a grant from the VA Health Services Research and Development Service. The research team also included Mary Vaughan-Sarrazin, Ph.D., UI adjunct assistant professor in internal medicine and a health services research specialist with the VA Iowa City Health Care System, and Gary Rosenthal, M.D., UI professor of internal medicine and director of the Center for Research in the Implementation of Innovative Strategies in Practice at the VA Iowa City Health Care System, where he also is a Quality Scholar.
STORY SOURCE: University of Iowa Health Science Relations, 5137 Westlawn, Iowa City, Iowa 52242-1178
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