Racial Differences in the Use of Invasive Cardiovascular Procedures in the Department of Veterans Affairs Medical System

Whittle, Jeff; Conigliaro, Joseph; Good, Chester B.; Lofgren, Richard P.

doi:10.1056/nejm199308263290907

Cited by 455 publications

(194 citation statements)

References 23 publications

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“…For example, although coronary heart disease (CHD) is the leading cause of death for African Americans in the United States [24,25], and cardiac revascularization procedures are well-established treatments for cardiovascular disease [26,27], a smaller proportion of African American patients than white patients receive such procedures in Veterans Administration (VA), Medicare, and other populations [28][29][30][31][32][33]. Aside from the significant disparities in cardiovascular procedures received, one study found that non-white pneumonia patients received fewer hospital services, with an accompanying longer hospital stay [34] than did white patients.…”

Section: Brief Background Of the Usphs-tuskegee Syphilis Study And Rementioning

confidence: 99%

The Tuskegee Legacy Project: history, preliminary scientific findings, and unanticipated societal benefits

Katz

Kegeles

Green

et al. 2003

Dental Clinics of North America

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SummaryThis article is intended to provide a relatively complete picture of how a pilot study-conceived and initiated within an NIDCR-funded RRCMOH-matured into a solid line of investigation within that center and "with legs"into a fully funded study within the next generation of NIDCR centers on this topic of health disparities, the Centers for Research to Reduce Oral Health Disparities. It highlights the natural opportunity that these centers provide for multicenter, cross-disciplinary research and for research career pipelining for college and dental school students; with a focus, in this case, on minority students.Furthermore, this series of events demonstrates the rich potential that these types of research centers have to contribute in ways that far exceed the scientific outcomes that form their core. In this instance, the NMOHRC played a central-and critical, if unanticipated-role in contributing to two events of national significance, namely the presidential apology to the African American community for the research abuses of the USPHS-Tuskegee syphilis study and the establishment of the National Center for Bioethics in Research and Health Care at Tuskegee University. Origins of the Tuskegee Legacy ProjectThe Tuskegee Legacy Project (TLP) has its origins in casual Web surfing by a biomedical reference librarian on her laptop computer on a fall evening in 1993 while relaxing in the dormer room, which served as the family den. Ms. B.J. Frey, Head Reference Librarian at the * Corresponding author. E-mail address: ralph.katz@nyu.edu (R.V. Katz).This research project was supported by NIDCR/NIH grant #P50 DE10592 (University of Medicine and Dentistry of New Jersey/ University of Connecticut Northeastern Minority Oral Health Research Center), and is currently supported in the analysis phase by NIDCR/NIH grant #U54 DE 14257 (NYU Oral Cancer RAAHP Center).Research Centers supported by the NIH are fully intended to create a vortex of scientific activity that goes well beyond the direct scientific aims of the studies initially funded within those centers. The maxim is that the whole should be greater than the sum of its initial constituent studies or parts. We believe that NMOHRC did indeed achieve that maxim-even extending "the whole" to include broad societal impact, well beyond the scope of important, but mere, scientific outcomes-all within the concept and appropriate functions of a scientific NIHfunded research center. NIH Public Access

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Section: Brief Background Of the Usphs-tuskegee Syphilis Study And Rementioning

confidence: 99%

The Tuskegee Legacy Project: history, preliminary scientific findings, and unanticipated societal benefits

Katz

Kegeles

Green

et al. 2003

Dental Clinics of North America

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“…In several studies that used administrative data, as well as medical record review, African-American patients were found to have lower utilization of diagnostic and therapeutic procedures. Whereas most analyses have been limited to cardiac catheterization, coronary angioplasty, and coronary bypass grafting, [1][2][3][4]6,7 others have reported less frequent surgical intervention for African-American patients with colorectal cancer, 12 breast cancer, 13,14 and bladder cancer, 15 as well as lower rates of outpatient preventive services. 16,17 Although the concept of race is somewhat tenuous and may be a surrogate for socioeconomic status, 18 two reports from the Veterans Administration have demonstrated lower rates of cardiovascular procedures in African Americans, 2,3 suggesting that social and clinical factors are also important.…”

Section: Discussionmentioning

confidence: 99%

“…The studies that have utilized administrative data have generally documented lower utilization of selected angiographic and surgical procedures in African-American patients [1][2][3][4] and female patients, 5,6 as well as poorer survival following diagnosis. 6,7 Moreover, in analyses that have been limited to patients with equal access to a health care system, racial differences in therapy have also been reported, 2,3,8 suggesting that factors other than access to care may be involved in treatment decisions.…”

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confidence: 99%

Lack of gender and racial differences in surgery and mortality in hospitalized medicare beneficiaries with bleeding peptic ulcer

et al. 1997

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OBJECTIVE: Determine the relation of race and gender to outcome from bleeding peptic ulcer. DESIGN:Retrospective cohort study. SETTING:All acute care hospitals in the United States.PATIENTS: A 100% sample of hospitalized Medicare beneficiaries older than 64 years ( n ‫؍‬ 82,868) with a primary discharge diagnosis of peptic ulcer with hemorrhage. MEASUREMENTS AND MAIN RESULTS:Surgical treatment was performed in 6.9% of patients, 30-day mortality was 8.5%, and average length of stay was 9.4 days. Surgery was somewhat more common in men than women (7.3% vs 6.5%, p Ͻ .001), and in whites than African Americans (6.9% vs 6.3%, p Ͻ .001), but neither race nor gender was associated with surgery in multivariable analysis adjusting for potentially confounding factors. Mortality rates were similar in African Americans and whites (8.5%), and somewhat higher in men than women (10.7% vs 9.3%, p Ͻ .001). In multivariable analysis, there was no difference in mortality across gender and racial groups. Although unadjusted and adjusted lengths of stay were longer for African Americans and shorter for men, the differences were modest (i.e., 16% increase and 6% decrease in multivariable analysis, respectively, p Ͻ .0001). CONCLUSIONS:In this national sample, there is no significant gender or racial difference in therapy and outcome for patients with hemorrhagic peptic ulcer. The findings raise the possibility that studies that have shown race and gender differences in management of coronary artery disease and cancer may not be generalizable to other common diagnoses.KEY WORDS: peptic ulcer; African Americans; women; Medicare.

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“…We focused these vignettes on cardiac care, given the well-supported evidence that blacks and women, despite clinically equivalent circumstances, are less likely to receive cardiac care procedures. 1,[19][20][21][22][23][24][25][26][27][28][29][30][31] Two clinically equivalent options for recommendations, one involving a procedure and the other a non-procedural option, were developed for each vignette. The vignettes were created under the premise that in situations where clinical equivalency does not allow a clear choice, social psychology concepts would suggest that students would then be forced to base their decisions on secondary, non-clinical factors, such as patient demographics.…”

Section: Methodsmentioning

confidence: 99%

Racial, Gender, and Socioeconomic Status Bias in Senior Medical Student Clinical Decision-Making: A National Survey

et al. 2015

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BACKGROUND:Research suggests stereotyping by clinicians as one contributor to racial and gender-based health disparities. It is necessary to understand the origins of such biases before interventions can be developed to eliminate them. As a first step toward this understanding, we tested for the presence of bias in senior medical students. OBJECTIVE: The purpose of the study was to determine whether bias based on race, gender, or socioeconomic status influenced clinical decision-making among medical students. DESIGN: We surveyed seniors at 84 medical schools, who were required to choose between two clinically equivalent management options for a set of cardiac patient vignettes. We examined variations in student recommendations based on patient race, gender, and socioeconomic status. PARTICIPANTS: The study included senior medical students. MAIN MEASURES: We investigated the percentage of students selecting cardiac procedural options for vignette patients, analyzed by patient race, gender, and socioeconomic status. KEY RESULTS: Among 4,603 returned surveys, we found no evidence in the overall sample supporting racial or gender bias in student clinical decision-making. Students were slightly more likely to recommend cardiac procedural options for black (43.9 %) vs. white (42 %, p=.03) patients; there was no difference by patient gender. Patient socioeconomic status was the strongest predictor of student recommendations, with patients described as having the highest socioeconomic status most likely to receive procedural care recommendations (50.3 % vs. 43.2 % for those in the lowest socioeconomic status group, p<.001). Analysis by subgroup, however, showed significant regional geographic variation in the influence of patient race and gender on decision-making. Multilevel analysis showed that white female patients were least likely to receive procedural recommendations. CONCLUSIONS: In the sample as a whole, we found no evidence of racial or gender bias in student clinical decision-making. However, we did find evidence of bias with regard to the influence of patient socioeconomic status, geographic variations, and the influence of interactions b e t w e e n p a t i e n t r ac e a nd g e nd er o n s t u d en t recommendations.

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Racial Differences in the Use of Invasive Cardiovascular Procedures in the Department of Veterans Affairs Medical System

Abstract: Even when financial incentives are absent, whites are more likely than blacks to undergo invasive cardiac procedures. These findings suggest that social or clinical factors affect the use of these procedures in blacks and whites.

Cited by 455 publications

References 23 publications

The Tuskegee Legacy Project: history, preliminary scientific findings, and unanticipated societal benefits

The Tuskegee Legacy Project: history, preliminary scientific findings, and unanticipated societal benefits

Lack of gender and racial differences in surgery and mortality in hospitalized medicare beneficiaries with bleeding peptic ulcer

Racial, Gender, and Socioeconomic Status Bias in Senior Medical Student Clinical Decision-Making: A National Survey

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