Access to coronary artery bypass surgery by race/ethnicity and gender among patients who are appropriate for surgery

Edward L. Hannan, Michelle Van Ryn, Jane Burke, Danice Stone, Dinesh Kumar, Djavad Arani, Walter Pierce, Shahrokh Rafii, Timothy A. Sanborn, Samin Sharma, James Slater, Barbara A. Debuono

Research output: Contribution to journalArticle

203 Citations (Scopus)

Abstract

OBJECTIVE. The study sought to determine if there were race/ethnicity or gender differences in access to coronary artery bypass graft (CABG) surgery among patients who have been designated as appropriate and as necessary for that surgery according to the RAND methodology. METHODS. RAND appropriateness and necessity criteria were used to identify a race/gender stratified sample of postangiography patients who would benefit from coronary artery bypass graft surgery. These patients were tracked for 3 months to determine if they had undergone coronary artery bypass graft surgery in New York State. Subjects were a total of 1,261 postangiography patients in eight New York hospitals in 1994 to 1996. Measures included percentages of patients for whom coronary artery bypass graft surgery was appropriate and necessary undergoing surgery by race/ethnicity and gender, as well as multivariate odds ratios for race/ethnicity and gender. RESULTS. After controlling for age, payer, number of vessels diseased, and presence of left main disease, African-American and Hispanic patients were found to be significantly less likely to undergo coronary artery bypass graft surgery than white non-Hispanic patients (respective odds ratios 0.64 and 0.60). When "necessity" was used as a criterion instead of "appropriateness," significant differences in access for African-American patients remained. The gatekeeper physician recommended surgery only 10% of the time that patients did not undergo "appropriate" coronary artery bypass graft surgery, and this percentage did not vary significantly by race/ethnicity or gender of the patient. CONCLUSIONS. Even after controlling for appropriateness and necessity for coronary artery bypass graft surgery in a prospective study, African-American patients had significant access problems in obtaining coronary artery bypass graft surgery. These problems appeared not to be related to patient refusals.

Original languageEnglish (US)
Pages (from-to)68-77
Number of pages10
JournalMedical Care
Volume37
Issue number1
DOIs
StatePublished - Jan 1999
Externally publishedYes

Fingerprint

Coronary Artery Bypass
surgery
ethnicity
gender
Transplants
African Americans
Odds Ratio
gatekeeper
Hispanic Americans
gender-specific factors
physician
Disease
Prospective Studies
Physicians
methodology

Keywords

  • Appropriateness
  • Bypass surgery
  • CABG surgery
  • Race and gender access

ASJC Scopus subject areas

  • Nursing(all)
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Health Professions(all)

Cite this

Access to coronary artery bypass surgery by race/ethnicity and gender among patients who are appropriate for surgery. / Hannan, Edward L.; Van Ryn, Michelle; Burke, Jane; Stone, Danice; Kumar, Dinesh; Arani, Djavad; Pierce, Walter; Rafii, Shahrokh; Sanborn, Timothy A.; Sharma, Samin; Slater, James; Debuono, Barbara A.

In: Medical Care, Vol. 37, No. 1, 01.1999, p. 68-77.

Research output: Contribution to journalArticle

Hannan, EL, Van Ryn, M, Burke, J, Stone, D, Kumar, D, Arani, D, Pierce, W, Rafii, S, Sanborn, TA, Sharma, S, Slater, J & Debuono, BA 1999, 'Access to coronary artery bypass surgery by race/ethnicity and gender among patients who are appropriate for surgery', Medical Care, vol. 37, no. 1, pp. 68-77. https://doi.org/10.1097/00005650-199901000-00010
Hannan, Edward L. ; Van Ryn, Michelle ; Burke, Jane ; Stone, Danice ; Kumar, Dinesh ; Arani, Djavad ; Pierce, Walter ; Rafii, Shahrokh ; Sanborn, Timothy A. ; Sharma, Samin ; Slater, James ; Debuono, Barbara A. / Access to coronary artery bypass surgery by race/ethnicity and gender among patients who are appropriate for surgery. In: Medical Care. 1999 ; Vol. 37, No. 1. pp. 68-77.
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AU - Kumar, Dinesh

AU - Arani, Djavad

AU - Pierce, Walter

AU - Rafii, Shahrokh

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N2 - OBJECTIVE. The study sought to determine if there were race/ethnicity or gender differences in access to coronary artery bypass graft (CABG) surgery among patients who have been designated as appropriate and as necessary for that surgery according to the RAND methodology. METHODS. RAND appropriateness and necessity criteria were used to identify a race/gender stratified sample of postangiography patients who would benefit from coronary artery bypass graft surgery. These patients were tracked for 3 months to determine if they had undergone coronary artery bypass graft surgery in New York State. Subjects were a total of 1,261 postangiography patients in eight New York hospitals in 1994 to 1996. Measures included percentages of patients for whom coronary artery bypass graft surgery was appropriate and necessary undergoing surgery by race/ethnicity and gender, as well as multivariate odds ratios for race/ethnicity and gender. RESULTS. After controlling for age, payer, number of vessels diseased, and presence of left main disease, African-American and Hispanic patients were found to be significantly less likely to undergo coronary artery bypass graft surgery than white non-Hispanic patients (respective odds ratios 0.64 and 0.60). When "necessity" was used as a criterion instead of "appropriateness," significant differences in access for African-American patients remained. The gatekeeper physician recommended surgery only 10% of the time that patients did not undergo "appropriate" coronary artery bypass graft surgery, and this percentage did not vary significantly by race/ethnicity or gender of the patient. CONCLUSIONS. Even after controlling for appropriateness and necessity for coronary artery bypass graft surgery in a prospective study, African-American patients had significant access problems in obtaining coronary artery bypass graft surgery. These problems appeared not to be related to patient refusals.

AB - OBJECTIVE. The study sought to determine if there were race/ethnicity or gender differences in access to coronary artery bypass graft (CABG) surgery among patients who have been designated as appropriate and as necessary for that surgery according to the RAND methodology. METHODS. RAND appropriateness and necessity criteria were used to identify a race/gender stratified sample of postangiography patients who would benefit from coronary artery bypass graft surgery. These patients were tracked for 3 months to determine if they had undergone coronary artery bypass graft surgery in New York State. Subjects were a total of 1,261 postangiography patients in eight New York hospitals in 1994 to 1996. Measures included percentages of patients for whom coronary artery bypass graft surgery was appropriate and necessary undergoing surgery by race/ethnicity and gender, as well as multivariate odds ratios for race/ethnicity and gender. RESULTS. After controlling for age, payer, number of vessels diseased, and presence of left main disease, African-American and Hispanic patients were found to be significantly less likely to undergo coronary artery bypass graft surgery than white non-Hispanic patients (respective odds ratios 0.64 and 0.60). When "necessity" was used as a criterion instead of "appropriateness," significant differences in access for African-American patients remained. The gatekeeper physician recommended surgery only 10% of the time that patients did not undergo "appropriate" coronary artery bypass graft surgery, and this percentage did not vary significantly by race/ethnicity or gender of the patient. CONCLUSIONS. Even after controlling for appropriateness and necessity for coronary artery bypass graft surgery in a prospective study, African-American patients had significant access problems in obtaining coronary artery bypass graft surgery. These problems appeared not to be related to patient refusals.

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KW - Bypass surgery

KW - CABG surgery

KW - Race and gender access

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