Racial variations in the choice of on-pump versus off-pump coronary artery bypass grafting

Abstract

Objective-To examine explanations of differences in utilization rates of a newly reintroduced technique -off-pump coronary artery bypass grafting (CABG) -between racial minorities and Whites.Method-The study was based on 15,313 CABG patients in the New York State Cardiac Surgery Reporting System covering all cardiac surgeons providing off-pump CABG in New York State. We estimated cross sectional, random effect regression models predicting the probability of offpump versus on-pump surgery.Results-Thirty one percent of Blacks, 20.7% of other races, and 23% of Whites underwent offpump CABG (P < 0.0001). The higher rates for Blacks arose mostly from being treated by surgeons performing only a few off-pump procedures rather than from surgeons performing many off-pump surgeries. After adjusting for clinical characteristics and coronary anatomy, Blacks

The Contribution of Economists to Understanding Racial Health Disparities in the US

“…Other researchers have studied provider originating potential mechanisms for disparities (Balsa and McGuire 2001;Balsa and McGuire 2003;McGuire and Miranda 2008;Mukamel et al 2006;Werner et al 2005); patient originating Han and Liu 2005;Wisnivesky et al 2005); differences in health deleterious behavior (Adimora et al 2002;Dynan 2008;Nelson et al 2007); regional variation in health status (Grann et al 2006); differences in health literacy (Howard et al 2006;Viswanath et al 2006); poor communication, compliance, or disease management (Asch and Brandt 2006;Clemens-Cope and Kenney 2007;McGuire and Miranda 2008); as well as differences in treatment (Barnato et al 2007Gurmankin et al 2004;Groenveld et al 2005;Mukamel et al 2007;Ray et al 2006;Shavers et al 2004). Bazzoli et al (2005) and Zuckerman et al (2001) have studied the impact of changing financial and policy environment on the viability and service provision of safety net hospitals, which disproportionately provide care to minority and immigrant populations.…”