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Do race and gender influence the use of invasive procedures?

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Abstract

OBJECTIVE: To assess the influence of race and gender on the use of invasive procedures in patients with acute myocardial infarction (AMI) in community hospitals.

DESIGN: Prospective, observational.

SETTING: Five mid-Michigan community hospitals.

PATIENTS: All patients (838) identified with AMI between January 1994 and April 1995 in 1 of these hospitals.

MEASUREMENTS AND MAIN RESULTS: After adjusting for age, hospital of admission, insurance type, severity of AMI, and comorbidity, using white men as the reference group, the rate of being offered cardiac catheterization (CC) was 0.88 (95% confidence interval [CI], 0.60 to 1.29) for white women; 0.79 (95% CI, 0.41 to 1.50) for black men; and 1.14 (95% CI, 0.53 to 2.45) for black women. Among patients who underwent CC, after also adjusting for coronary artery anatomy, the rate of being offered angioplasty, using white men as the reference group, was 1.22 (95% CI, 0.75 to 1.98) for white women; 0.61 (95% CI, 0.29 to 1.28; P=.192) for black men; and 0.40 (95% CI, 0.14 to 1.13) for black women. The adjusted rate of being offered bypass surgery was 0.47 (95% CI, 0.24 to 0.89) for white women; 0.36 (95% CI, 0.12 to 1.06) for black men; and 0.37 (95% CI, 0.11 to 1.28) for black women.

CONCLUSIONS: Our study shows that white women are less likely than white men to be offered bypass surgery after AMI. Although black men and women with AMI are less likely than white men to be offered percutaneous transluminal coronary angioplasty or coronary artery bypass grafting in both unadjusted and adjusted analyses, these findings did not reach statistical significance. Our study is limited in power due to the small number of blacks in the sample.

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Author information

Author notes

  1. Aryeh D. Stein PhD

    Present address: the Department of International Health, Rollins School of Public Health, Emory University, Atlanta, Ga.

  2. Raj Mitra MD

    Present address: Harvard Medical School, Boston, Mass

  3. Joel Kupersmith MD

    Present address: Texas Tech School of Medicine, Lubbock, Tex.

Authors and Affiliations

  1. the College of Human Medicine, Michigan State University, East Lansing, Mich

    Ralph E. Watson MD,  Aryeh D. Stein PhD, Francesca C. Dwamena MD, Jill Kroll PhD,  Raj Mitra MD, Barbara A. McIntosh MD, Peter Vasilenko III PhD, Margaret M. Holmes-Rovner PhD, Qin Chen MD &  Joel Kupersmith MD

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  1. Ralph E. Watson MD
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Michigan State University Inter-Institutional Collaborative Heart Study Group

Additional information

The Blue Cross/Blue Shield of Michigan Foundation, Michigan State University Foundation, the College of Human Medicine at Michigan State University, and all hospitals involved in the study provided funding for this project, Dr. George Rowan of the David Walker Research Institute at Michigan State University provided assistance in obtaining funding.

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Watson, R.E., Stein, A.D., Dwamena, F.C. et al. Do race and gender influence the use of invasive procedures?. J GEN INTERN MED 16, 227–234 (2001). https://doi.org/10.1046/j.1525-1497.2001.016004227.x

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