Clinical Research
Race and Heart Disease
Impact of Hospital Volume on Racial Disparities in Cardiovascular Procedure Mortality

https://doi.org/10.1016/j.jacc.2005.08.068Get rights and content
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Objectives

We assessed use of low-volume hospitals by race and ethnicity for major cardiovascular procedures and determined whether hospital volume is an important factor explaining racial and ethnic differences in post-procedure mortality.

Background

Low hospital volume predicts mortality for cardiovascular procedures and could be a mediator of racial and ethnic differences in procedure outcomes.

Methods

We analyzed data from 719,679 hospitalizations for cardiac artery bypass grafting (CABG), percutaneous transluminal coronary angioplasty (PTCA), abdominal aortic aneurysm (AAA) repair, and carotid endarterectomy (CEA) from 1998 to 2001 using the Nationwide Inpatient Sample. We used multivariate logistic regression to assess whether race predicts use of low-volume hospitals and the relative contribution of hospital volume to racial disparity in post-procedure in-hospital mortality.

Results

Black and Hispanic patients were more likely than white patients to receive cardiovascular procedures in low-volume hospitals. Black patients had greater risk-adjusted mortality than white patients after elective AAA repair (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.20 to 2.84), CABG (OR, 1.19; 95% CI, 1.06 to 1.33), and CEA (OR, 1.56; 95% CI, 1.07 to 2.27), but not PTCA. Hispanic patients did not have higher risk-adjusted mortality than white patients. Adjusting for hospital volume did not substantially reduce the relative risk of death for black patients compared with white patients.

Conclusions

Black and Hispanic patients were more likely to receive cardiovascular procedures in low-volume hospitals, but hospital volume did not explain a large proportion of racial differences in post-procedure mortality. Additional research is needed to determine why black patients have increased mortality after cardiovascular procedures and how these mortality rates can be reduced.

Abbreviations and Acronyms

AAA
abdominal aortic aneurysm
AHRQ
Agency for Healthcare Research and Quality
CABG
coronary artery bypass graft
CEA
carotid endarterectomy
CON
certificate of need
ICD-9-CM
International Classification of Diseases-9th edition-Clinical Modification
NIS
Nationwide Inpatient Sample
PTCA
percutaneous transluminal coronary angioplasty

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Supported by an institutional National Research Service Award (No. 5 T32 HP11001-15) from the Health Resources and Services Administration (HRSA), Washington, DC, and by an institutional National Research Service Award (No. 5 T32 HS000020-20) from the Agency for Healthcare Research and Quality, Washington, DC.