Older whites are 3 1/2 times more likely than older blacks to receive potentially life-saving surgery to bypass a blocked coronary artery, according to a new study that offers striking evidence of a wide racial gap in access to medical care.
The study, based on more than 86,000 coronary artery bypass graft surgeries performed under the Medicare program, found that the gap was widest in Southeastern states, where whites were more than six times as likely to have the operation as blacks. It also found that the procedure was five times more prevalent among white men than black men.
"It is possible that some patients are dying of heart attacks that could have been prevented with surgery," said Dr. Arthur J. Hartz, a co-author. The authors of the study, published in today's Journal of the American Medical Association, said that the racial disparity might be traceable to several factors, including black poverty, reluctance to undergo surgery and physicians' racial prejudice.
Because the study covered patients who already have insurance under Medicare, a form of national health insurance for people over 65, they said that the findings suggest that social and cultural factors could interfere with access to care even if a broader national health insurance plan is put into place.
They and others called for efforts to educate lower-income and minority patients about the benefits of procedures such as bypass surgery, and to point out to physicians factors in the health-care system that might lead to racial inequities.
The new study, led by researchers at the Medical College of Wisconsin in Milwaukee, is not the first to show a racial gap in medical care. Others have shown that access to kidney transplantation, cardiac catheterization and other high-technology procedures, including bypass surgeries, are affected by race.
But the Wisconsin group's study is the most comprehensive so far, covering the entire country, as well as individual regions. It is also the first to look at patterns of use under Medicare, a federal program for which nearly all elderly Americans are eligible.
Using 1986 Medicare program data, the researchers used records of hospitalizations for heart attack to estimate the prevalence of heart disease by race. Then they used records of bypass graft operations to estimate rates of the surgery among blacks and whites.
While there appeared to be little difference in heart disease rates between blacks and whites, the rate of coronary artery bypass graft surgery was 27.1 per 10,000 for whites and only 7.6 per 10,000 for blacks.
Kenneth C. Goldberg, the paper's lead author, said the greater vTC poverty of blacks could keep some from major surgery. While Medicare covers much of a person's treatment, patients still must pay a deductible and a percentage of their hospital bill.
Dr. Jay Brown, chief of cardiology at Harlem Hospital and president of the Association of Black Cardiologists, suggested that the racial disparity in coronary artery bypass graft surgeries may be partially explained by an overuse of the pricey procedure in whites with good health insurance.