A. G. Sassine1, J. Nosewicz1, F. Aboona1, T. Siblini1, J. M. Clements1 1Central Michigan University College Of Medicine,Mount Pleasant, MI, USA
Introduction:
Racial disparities in the utilization of coronary artery bypass graft surgery (CABG) have been documented in certain parts of the country. The influence of insurance status on these racial disparities has been inconsistently reported. Apart from regional studies documenting these disparities, to our knowledge, no studies have examined disparities at the national level. Our objective was to assess racial disparities in CABG utilization using national discharge data from the 2012 National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. We hypothesize that minority populations are less likely than whites to receive CABG and that these racial disparities will persist when controlling for insurance.
Methods:
We identified 456,895 discharges with a diagnosis code for acute myocardial infarction (ICD 9 CM code 410.x1 or 410.x3) that also had a CABG procedure code (ICD 9 CM Code 36.10-36.16, 36.19) in any of the 15 procedure code fields. We ran logistic regression models to determine the influence of age, number of chronic conditions, gender, rural/urban patient location, race, and insurance status on undergoing CABG surgery.
Results:
Blacks (OR=.794, 95% CI .742-.849) were less likely than Whites to receive CABG when controlling for all demographic variables, including insurance status. This disparity persists when including an interaction term between race and insurance with Blacks on Medicaid being less likely to receive CABG compared to whites with Private/HMO insurance (OR = ..777, 95% CI .690-.874). Hispanics (OR=1.13, 95% CI 1.06-1.22) and Asian/Pacific Islanders (OR=1.55, 95% CI 1.40-1.70) are more likely to receive CABG compared to whites. However, compared to whites with Private/HMO insurance, Hispanics (OR-.852, 95% CI .781-.930) and Asians (OR=0.764, 95% CI .669-.874) on Medicare are less likely to receive CABG, indicating that insurance status completely moderates the effect of race on CABG for these race/ethnic groups. Native Americans were as likely as whites to receive CABG across all logit models.
Conclusion:
Disparities in CABG utilization for Black AMI patients were not explained by the interaction effect between race and insurance; however, insurance status appears to moderate the effects of race for Hispanics and Asian/Pacific Islanders. These findings suggest policies be implemented that improve access to invasive revascularization procedures for African Americans. Future studies should evaluate why the positive effects of race for Hispanics and Asian/Pacific Islanders is negated by insurance status, specifically public insurance programs such as Medicare.