Examination of racial differences in management of cardiovascular disease

Jeffrey A. Ferguson, William M. Tierney, Glenda R. Westmoreland, Lorrie A. Mamlin, Douglas S. Segar, George J. Eckert, Xiao Hua Zhou, Douglas Martin, Morris Weinberger

Research output: Contribution to journalArticle

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Abstract

Objectives. We sought to identify the clinical characteristics associated with, and to investigate the impact of cohort selection criteria on, interfacial use of invasive cardiac procedures and to determine survival. Background. Although interfacial differences in the use of invasive cardiac procedures have been previously reported, the underlying reasons are not known. Methods. A retrospective cohort study was conducted at a Veterans Affairs Medical Center. Study patients were evaluated for cardiovascular disease between January 1 and December 31, 1993. Results. The study included 1,406 male patients (85% white, 58% married), with a mean age of 63.4 years. African Americans were less likely than whites to undergo procedures (cardiac catheterization: odds ratio [OR] 0.37, 95% confidence interval [CI] 0.24 to 0.58; coronary angioplasty: OR 0.60, 95% CI 0.25 to 1.49; coronary bypass surgery: OR 0.22, 95% CI 0.08 to 0.63; any procedure: OR 0.32, 95% CI 0.21 to 0.50). On bivariate analysis, patients who underwent cardiac procedures were more likely to be younger, married and reside nonlocally and less likely to have severe comorbid disease; however, African Americans were less likely to be married and to reside nonlocally and more likely to have severe comorbid disease. Cohorts adjusting for referral status and specified cardiac diagnoses reduced or reversed interracial treatment differences. Thirty-day and 1-year survival rates (96% and 87.6%, respectively) were equivalent. Conclusions. Racial disparity in invasive cardiac procedure use may be partially explained by clinical differences and cohort selection bias. Despite treatment differences, survival rates were equivalent in African Americans and whites.

Original languageEnglish
Pages (from-to)1707-1713
Number of pages7
JournalJournal of the American College of Cardiology
Volume30
Issue number7
DOIs
StatePublished - Dec 1997

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Cardiovascular Diseases
Odds Ratio
African Americans
Confidence Intervals
Survival Rate
Selection Bias
Veterans
Cardiac Catheterization
Angioplasty
Patient Selection
Cohort Studies
Referral and Consultation
Retrospective Studies
Survival
Therapeutics

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Ferguson, J. A., Tierney, W. M., Westmoreland, G. R., Mamlin, L. A., Segar, D. S., Eckert, G. J., ... Weinberger, M. (1997). Examination of racial differences in management of cardiovascular disease. Journal of the American College of Cardiology, 30(7), 1707-1713. https://doi.org/10.1016/S0735-1097(97)00365-3

Examination of racial differences in management of cardiovascular disease. / Ferguson, Jeffrey A.; Tierney, William M.; Westmoreland, Glenda R.; Mamlin, Lorrie A.; Segar, Douglas S.; Eckert, George J.; Zhou, Xiao Hua; Martin, Douglas; Weinberger, Morris.

In: Journal of the American College of Cardiology, Vol. 30, No. 7, 12.1997, p. 1707-1713.

Research output: Contribution to journalArticle

Ferguson, JA, Tierney, WM, Westmoreland, GR, Mamlin, LA, Segar, DS, Eckert, GJ, Zhou, XH, Martin, D & Weinberger, M 1997, 'Examination of racial differences in management of cardiovascular disease', Journal of the American College of Cardiology, vol. 30, no. 7, pp. 1707-1713. https://doi.org/10.1016/S0735-1097(97)00365-3
Ferguson JA, Tierney WM, Westmoreland GR, Mamlin LA, Segar DS, Eckert GJ et al. Examination of racial differences in management of cardiovascular disease. Journal of the American College of Cardiology. 1997 Dec;30(7):1707-1713. https://doi.org/10.1016/S0735-1097(97)00365-3
Ferguson, Jeffrey A. ; Tierney, William M. ; Westmoreland, Glenda R. ; Mamlin, Lorrie A. ; Segar, Douglas S. ; Eckert, George J. ; Zhou, Xiao Hua ; Martin, Douglas ; Weinberger, Morris. / Examination of racial differences in management of cardiovascular disease. In: Journal of the American College of Cardiology. 1997 ; Vol. 30, No. 7. pp. 1707-1713.
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abstract = "Objectives. We sought to identify the clinical characteristics associated with, and to investigate the impact of cohort selection criteria on, interfacial use of invasive cardiac procedures and to determine survival. Background. Although interfacial differences in the use of invasive cardiac procedures have been previously reported, the underlying reasons are not known. Methods. A retrospective cohort study was conducted at a Veterans Affairs Medical Center. Study patients were evaluated for cardiovascular disease between January 1 and December 31, 1993. Results. The study included 1,406 male patients (85{\%} white, 58{\%} married), with a mean age of 63.4 years. African Americans were less likely than whites to undergo procedures (cardiac catheterization: odds ratio [OR] 0.37, 95{\%} confidence interval [CI] 0.24 to 0.58; coronary angioplasty: OR 0.60, 95{\%} CI 0.25 to 1.49; coronary bypass surgery: OR 0.22, 95{\%} CI 0.08 to 0.63; any procedure: OR 0.32, 95{\%} CI 0.21 to 0.50). On bivariate analysis, patients who underwent cardiac procedures were more likely to be younger, married and reside nonlocally and less likely to have severe comorbid disease; however, African Americans were less likely to be married and to reside nonlocally and more likely to have severe comorbid disease. Cohorts adjusting for referral status and specified cardiac diagnoses reduced or reversed interracial treatment differences. Thirty-day and 1-year survival rates (96{\%} and 87.6{\%}, respectively) were equivalent. Conclusions. Racial disparity in invasive cardiac procedure use may be partially explained by clinical differences and cohort selection bias. Despite treatment differences, survival rates were equivalent in African Americans and whites.",
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AU - Zhou, Xiao Hua

AU - Martin, Douglas

AU - Weinberger, Morris

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N2 - Objectives. We sought to identify the clinical characteristics associated with, and to investigate the impact of cohort selection criteria on, interfacial use of invasive cardiac procedures and to determine survival. Background. Although interfacial differences in the use of invasive cardiac procedures have been previously reported, the underlying reasons are not known. Methods. A retrospective cohort study was conducted at a Veterans Affairs Medical Center. Study patients were evaluated for cardiovascular disease between January 1 and December 31, 1993. Results. The study included 1,406 male patients (85% white, 58% married), with a mean age of 63.4 years. African Americans were less likely than whites to undergo procedures (cardiac catheterization: odds ratio [OR] 0.37, 95% confidence interval [CI] 0.24 to 0.58; coronary angioplasty: OR 0.60, 95% CI 0.25 to 1.49; coronary bypass surgery: OR 0.22, 95% CI 0.08 to 0.63; any procedure: OR 0.32, 95% CI 0.21 to 0.50). On bivariate analysis, patients who underwent cardiac procedures were more likely to be younger, married and reside nonlocally and less likely to have severe comorbid disease; however, African Americans were less likely to be married and to reside nonlocally and more likely to have severe comorbid disease. Cohorts adjusting for referral status and specified cardiac diagnoses reduced or reversed interracial treatment differences. Thirty-day and 1-year survival rates (96% and 87.6%, respectively) were equivalent. Conclusions. Racial disparity in invasive cardiac procedure use may be partially explained by clinical differences and cohort selection bias. Despite treatment differences, survival rates were equivalent in African Americans and whites.

AB - Objectives. We sought to identify the clinical characteristics associated with, and to investigate the impact of cohort selection criteria on, interfacial use of invasive cardiac procedures and to determine survival. Background. Although interfacial differences in the use of invasive cardiac procedures have been previously reported, the underlying reasons are not known. Methods. A retrospective cohort study was conducted at a Veterans Affairs Medical Center. Study patients were evaluated for cardiovascular disease between January 1 and December 31, 1993. Results. The study included 1,406 male patients (85% white, 58% married), with a mean age of 63.4 years. African Americans were less likely than whites to undergo procedures (cardiac catheterization: odds ratio [OR] 0.37, 95% confidence interval [CI] 0.24 to 0.58; coronary angioplasty: OR 0.60, 95% CI 0.25 to 1.49; coronary bypass surgery: OR 0.22, 95% CI 0.08 to 0.63; any procedure: OR 0.32, 95% CI 0.21 to 0.50). On bivariate analysis, patients who underwent cardiac procedures were more likely to be younger, married and reside nonlocally and less likely to have severe comorbid disease; however, African Americans were less likely to be married and to reside nonlocally and more likely to have severe comorbid disease. Cohorts adjusting for referral status and specified cardiac diagnoses reduced or reversed interracial treatment differences. Thirty-day and 1-year survival rates (96% and 87.6%, respectively) were equivalent. Conclusions. Racial disparity in invasive cardiac procedure use may be partially explained by clinical differences and cohort selection bias. Despite treatment differences, survival rates were equivalent in African Americans and whites.

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