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Impact of availability of hospital-based invasive cardiac services on racial differences in the use of these services

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AMERICAN HEART JOURNAL 1999年第3期138卷 507-517页

作者： Gregory, PM Rhoads, GG Wilson, AC O'Dowd, KJ Kostis, JB UMDNJ Robert Wood Johnson Med Sch Dept Family Med Hlth Serv Res Program New Brunswick NJ 08903 USA Univ Med & Dent New Jersey Robert Wood Johnson Med Sch Dept Med New Brunswick NJ 08903 USA Rutgers State Univ New Jersey Grad Program Publ Hlth Piscataway NJ USA NJDHSS Trenton NJ USA

Background Reports indicate thai black patients ore less likely than white patients to receive invasive cardiac services after hospitalization for acute myocardial infarction (AMI). There is still uncertainty as to why racial differences exist and how they affect patient outcomes. This is the first study to focus on the availability of invasive cardiac services and racial differences in procedure use. Study objectives were to (1) document whether racial differences existed in the use of invasive cardiac procedures, (2) study whether these racial differences were related to availability of hospital-based invasive cardiac services at First admission for AMI, and (3) determine whether there were racial differences in long-term mortality rates. Methods A historical cohort study was conducted with discharge records from all acute care hospitals in New Jersey For 1993 linked to death certificate records for 1993 and 1994. There were 13,690 black and white New Jersey residents hospitalized with primary diagnosis of AMI. Use of cardiac catheterization within 90 days, revascularization within 90 days (percutaneous transluminal coronary angioplasty [PTCA] or coronary artery bypass graft surgery [CABG]), and death within 1 year after admission for AMI were the main outcome measures. Patterns for PTCA and CABG as separate outcomes were also studied. Hospital-based cardiac services available were described as no invasive cardiac services, catheterization only, or PTCA/CABG. To account for payer status and comorbidity differences, patients 65 years and older with Medicare coverage were analyzed separately from those younger than 65 years. Results slack patients aged 65 and older were generally less likely to receive catheterization and revascularization than white patients, regardless of facilities available at first admission. For patients younger than 65 years, the greatest differences between black and white patients in catheterization and PTCA/CABG use within 90 days after AM

关键词：非洲裔美国人/统计学和数值数据非洲大陆世系人群血管成形术经腔经皮冠状动脉/利用队列研究冠状动脉分流术/利用欧洲大陆世系人群/统计学和数值数据卫生服务易得程度心脏导管插入术/利用住院/统计学和数值数据心肌梗死/人种学心肌梗死/死亡率心肌梗死/外科学新泽西/流行病学回顾性研究老年人女(雌)性人类男(雄)性中年人

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Is race a poor prognostic factor in breast cancer?

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JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 1999年第1期189卷 41-45页

作者： El-Tamer, MB Homel, P Wait, RB SUNY Brooklyn Hlth Sci Ctr Brooklyn NY USA

Background: African American breast cancer patients have a higher mortality rate than their Caucasian counterparts. The purpose of this study was to evaluate whether race is a poor prognostic factor in breast cancer survival after multiple other prognostic factors are taken into account. Study Design: The tumor registry data from two institutions between the years 1982 and 1995 were combined for the analysis. A total of 1,745 patients, including 1,297 African American and 448 Caucasian women, were available for analysis. Race, age, income, stage, histologic findings, type of operation, and treating institution were evaluated as possible key prognostic variables. Results: In a univariate Cox proportional hazards regression analysis, African American patients with breast cancer were 1.27 times more likely to die than Caucasians when death from disease was measured (p = 0.01, 35% confidence interval 1.03 to 1.47). When all factors were included in a Cox regression analysis, only the stage of disease at diagnosis, age, and whether the patient had a therapeutic surgical treatment were statistically significant. Race, income, hospital, and histologic findings were not significant, although they were significant when used in a univariate analysis. Conclusions: poor survival of African American breast cancer patients seems to be related to their advanced stage at presentation and young age. To improve survival in these women, efforts should be concentrated on aggressive screening at a young age to detect the disease at an earlier stage. (J Am Cell Surg 1999;189:41-45. (C) 1999 by the American College of Surgeons).

关键词：非洲裔美国人/统计学和数值数据年龄分布乳腺肿瘤/人种学乳腺肿瘤/死亡率乳腺肿瘤/病理学欧洲大陆世系人群/统计学和数值数据收入/统计学和数值数据肿瘤分期纽约/流行病学预后登记/统计学和数值数据危险成年人老年人老年人 80以上女(雌)性人类中年人

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Race and sex differences in the refusal of cardiac catheterization among elderly patients hospitalized with acute myocardial infarction

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AMERICAN HEART JOURNAL 2002年第6期144卷 1052-1056页

作者： Rathore, SS Ordin, DL Krumholz, HM Yale Univ Sch Med Sect Cardiovasc Med Dept Internal Med New Haven CT 06520 USA Yale Univ Sch Med Sect Hlth Policy & Adm Dept Epidemiol & Publ Hlth New Haven CT 06520 USA Ctr Medicare & Medicaid Serv Boston MA USA Yale New Haven Med Ctr Ctr Outcomes Res & Evaluat New Haven CT 06504 USA Qualidigm Middletown CT USA

Background Prior studies have reported race and sex differences in cardiac catheterization use after acute myocardial infarction (AMI). It is unclear whether race or sex differences in procedure refusal may contribute to this difference. We sought to determine whether cardiac catheterization refusal rates differ by patient race or sex. Methods We evaluated medical records of 74,745 Medicare beneficiaries hospitalized for AMI between January 1994 and February 1996 to ascertain refusal of cardiac catheterization during hospitalization. Patient race and sex were evaluated for their association with cardiac catheterization refusal adjusting for patient, physician, and hospital characteristics. Results The cardiac catheterization refusal rate in the overall cohort was 2.92% (95% CI 2.80%-3.04%). Race and sex differences in cardiac catheterization were observed after multivariate adjustment, with white women (odds ratio [OR] 1.28), black men (OR 1.34), and black women (OR 1.37) more likely to refuse cardiac catheterization than white men (OR 1.00). Relative differences in refusal were associated with only modest absolute differences in risk-standardized rates of cardiac catheterization refusal;rates were lowest for white men (2.55%), and higher for white women (3.21%), black men (3.36%), and black women (3.38%, P <.001 for global comparison). Conclusions Patient race and sex were associated with cardiac catheterization refusal among elderly patients hospitalized with AMI. However, absolute race and sex differences in rates of procedure refusal were small, suggesting that race and sex differences in cardiac catheterization refusal provide only a partial explanation of observed differences in cardiac procedure use.

关键词：非洲裔美国人/统计学和数值数据欧洲大陆世系人群/统计学和数值数据心脏导管插入术/利用住院 Logistic模型心肌梗死/流行病学心肌梗死/人种学心肌梗死/治疗性别因素社会经济因素患者拒绝治疗/人种学患者拒绝治疗/统计学和数值数据美国/流行病学老年人女(雌)性人类男(雄)性

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Racial differences in outcomes of veterans undergoing percutaneous coronary interventions

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AMERICAN HEART JOURNAL 2001年第2期142卷 309-313页

作者： Maynard, C Wright, SM Every, NR Ritchie, JL Dept Vet Affairs Dept Med & Hlth Serv Res & Dev Seattle WA 98108 USA Univ Washington Dept Hlth Serv Dept Med Seattle WA 98195 USA Boston Hlth Care Syst Dept Vet Affairs Massachusetts Vet Epidemiol Res Informat Ctr W Roxbury MA USA

Background In the era of stenting relatively little is known about racial differences in the outcomes of percutaneous interventions (PCI). The purpose of this study was to determine whether there were racial differences with respect to short- and long-term outcomes in veterans undergoing PCI. Methods We used the national Department of Veterans Affairs (VA) patient treatment file to identify 24,625 African American and white veterans who had PCI in VA medical centers between October 1, 1994, and September 30, 1999. Baseline demographic characteristics were obtained, as was a measure of comorbidity. Short-term outcomes included hospital mortality and same-admission coronary artery bypass surgery, and long-term outcomes were vital status and rehospitalization. Multivariate statistical methods were used to adjust for patient differences when comparing both short- and long-term outcomes for African American and white veterans. Results African Americans were 11% of veterans, and in comparison with their white counterparts had more hypertension, diabetes, and acute myocardial infarction. African Americans less often underwent stenting (44% vs 49%), although hospital mortality (2.0% vs 1.9%) and same-admission bypass surgery (1.9% vs 2.2%) rates were similar, Two-year survival was 89% in African Americans and 91% in white veterans (P=.0014), and after adjustment for covariates African Americans had slightly higher mortality rates (hazard ratio 1.11, 95% confidence interval 1.05-1.17). At 2 years almost 61% of both African American and white veterans were rehospitalized for any reason. Conclusion Short- and long-term outcomes for African American and white veterans undergoing PCI in VA medical centers were similar, although African Americans underwent stenting less often.

关键词：非洲裔美国人/统计学和数值数据血管成形术经腔经皮冠状动脉/利用欧洲大陆世系人群/统计学和数值数据医院死亡率医院退伍军人/统计学和数值数据医院退伍军人/利用心肌梗死/人种学心肌梗死/死亡率心肌梗死/治疗结果评价(卫生保健) 支架/利用存活率分析美国/流行病学退伍军人/统计学和数值数据女(雌)性人类男(雄)性中年人

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Racial differences in the use of invasive cardiac procedures: A continuous quality improvement approach approach

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AMERICAN HEART JOURNAL 1999年第3期138卷 396-399页

作者： Sheifer, SE Schulman, KA Georgetown Univ Med Ctr Clin Econ Res Unit Washington DC 20007 USA Georgetown Univ Med Ctr Dept Med Div Cardiol Washington DC 20057 USA

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Description of a mixed ethnic, elderly population. III. Special diets, food preferences, and medicinal intakes

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JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES 1999年第6期54卷 M329-M332页

作者： Prothro, JW Rosenbloom, CA Georgia State Univ Dept Nutr Atlanta GA 30303 USA

Background The objective was to assess the use of physician-prescribed special diets, food preferences, and daily and occasional drug use by elderly participants in a Title III-C Nutrition Program. Methods. Data were collected by nonrandom interviews of congregate and meals-on-wheels clients. Chi-square was used to assess whether food and drug behaviors were related to six population variables: ethnicity, age, gender, congregate versus meals-on-wheels clients, proportion of noon meal usually eaten, and whether clients lived alone or with others. Results. Special diets and daily and occasional medications showed no significant differences with regard to the six variables. Broccoli was the food disliked most frequently. Suggestions that certain foods be served more frequently were greater among white than black clients (p <.001) and among home delivery than among congregate clients (p <.005). Persons who regularly ate half or less of the noon meal made more suggestions for cooking foods differently (p <.005) and had longer lists of favorite foods (p <.001) than those who usually ate most of or all of the meal. Persons who Lived alone had more suggestions for cooking foods differently (p <.005) and serving certain items more often (p <.05) than those who lived with other persons. Favorite foods, changes in cooking methods, and frequency of offering certain foods were not related significantly to age or to gender. Conclusions. Certain suggested changes in food choices and preparation can be implemented within Title III guidelines and may improve food intakes. While medicinal intakes were similar to those reported previously for the elderly cohort there is reason for concern with regard to drug-induced illness.

关键词：非洲裔美国人/统计学和数值数据老年人膳食疗法/统计学和数值数据药物疗法/统计学和数值数据欧洲大陆世系人群/统计学和数值数据偏食食品服务老人疗养院营养调查老年人 80以上女(雌)性人类男(雄)性

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Determinants of health services utilization among the black and white elderly.

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Journal of health & social policy 1990年第3期1卷 73-88页

作者： Keith, V.M. Jones, W. Texas A&M University College Station 77843.

Andersen's (1968) behavioral model was used to assess whether factors predictive of health services utilization are the same or different for elderly blacks and whites. We hypothesized that because the black elderly have fewer resources, lower psychological well-being, and are in worse health, situational and attitudinal factors suggested by the model have different effects for blacks and whites. Using three measures of utilization--physician contact, hospital contact, and nights hospitalized--our findings show some support for differential effects, particularly in the case of physician contact. Neither resource factors such as health insurance nor psychological well-being were predictive of utilization within the black population. We conclude with some suggestions for future research.

关键词：非洲裔美国人/统计学和数值数据行为欧洲大陆世系人群/统计学和数值数据卫生服务需求/统计学和数值数据老年人保健服务/利用健康状况指标医院/利用模型心理学医师/利用社会经济因素美国老年人人类

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Re: Race and differences in breast cancer survival in a managed care population

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JOURNAL OF THE NATIONAL CANCER INSTITUTE 2000年第20期92卷 1690-1691页

作者： Dunmore, C Plummer, P Regan, G Mattingly, D Jackson, S Millikan, R Univ N Carolina Dept Epidemiol Lineberger Comprehens Canc Ctr Chapel Hill NC 27599 USA

Yood et al. (1) reported that differences in survival between African-American and white breast cancer patients were negligible after adjustment for age, income, marital status, and stage at diagnosis. The authors studied enrollees in a managed care program where African-American and white women had equal access to health care and similar surgical treatment for breast cancer (2). We determined whether racial differences exist in the surgical treatment for breast cancer within the general population and whether this relationship is altered by adjustment for sociodemographic variables. We used data collected from The Carolina Breast Cancer Study, a population-based case–control study in North Carolina (3). The study was approved by the Institutional Review Board at the University of North Carolina School of Medicine. Multiple logistic regression was used to estimate odds ratios for the type of surgery received: mastectomy (including simple mastectomy, modified radical mastectomy, and total mastectomy) versus breast-conserving surgery (lumpectomy, segmental mastectomy, partial mastectomy, and quandrantectomy). The results of our analysis are presented in Table 1. Taken singly without adjustment for other predictors, the strongest predictors of receiving a mastectomy were later stage at diagnosis (based upon the American Joint Committee on Cancer (AJCC) TNM staging system), lower educational level, lower income, residence in a rural area or small town, and African-American race. After mutual adjustment for all predictors, the strongest predictors were later stage at diagnosis, lower educational level, and residence in a rural area or small town. African-American women were more likely to undergo mastectomy than white women [odds ratio (OR) = 1.5; 95% confidence interval (CI) = 1.1–2.0], but the association disappeared after mutual adjustment for all predictors (OR = 1.1; 95% CI = 0.8–1.7). Our results are similar to those of Muss et al. (4). Muss et al. found that fewer

关键词：非洲裔美国人/统计学和数值数据乳腺肿瘤/死亡率乳腺肿瘤/治疗教育程度欧洲大陆世系人群/统计学和数值数据管理医疗规划/统计学和数值数据乳房切除术/方法危险因素农村人口存活率美国/流行病学女(雌)性人类

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The interactive effects of race and ethnicity and mother's residence on the adequacy of prenatal care

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JOURNAL OF RURAL HEALTH 1996年第1期12卷 6-18页

作者： Miller, MK Clarke, LL Albrecht, SL Farmer, FL UNIV FLORIDA HLTH SCI CTRINST HLTH POLICY RESPOB 100177GAINESVILLEFL 32610 USA

Adequate prenatal care is known to reduce the risks of low birth weight and neonatal death, yet nearly one quarter of all women giving birth in the United States receive delayed, inadequate or no prenatal care. This suboptimal use of prenatal care has contributed to rates of low birth weight and neonatal mortality higher than those in most other industrialized nations. This paper examines the relationships among race/ethnicity, residence, maternal sociodemographic and medical risk characteristics, and use of prenatal care in the United States. Using data from the National Maternal and Infant Health Survey, this study found important differences in prenatal cave use by race/ethnicity and residence, as well as interactive effects of these variables. Single marital status, nonmetropolitan residence, poverty, low level of education, and no insurance were move strongly associated with inadequate prenatal care for whites and Hispanics than for blacks. Nonmetropolitan residents were more likely to receive inadequate care, regardless of race/ethnicity or sociodemographic characteristics. Predicted probabilities of prenatal care use by race/ethnicity and residence showed that, regardless of risk, nonmetropolitan Hispanic women had the highest probability of obtaining inadequate prenatal care. Results highlight the continued importance of race/ethnicity and rural residence in determining prenatal care use and the need to design interventions targeted to these populations.

关键词：非洲裔美国人/统计学和数值数据欧洲大陆世系人群/统计学和数值数据西班牙裔美国人/统计学和数值数据产前保健/标准产前保健/利用卫生保健质量/统计学和数值数据问卷调查回归分析危险因素农村人口抽样研究社会经济因素美国/流行病学市区人口女(雌)性人类妊娠

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THE CONSEQUENCES AND COSTS OF MATERNAL SUBSTANCE-ABUSE IN NEW-YORK-CITY - A POOLED TIME-SERIES, CROSS-SECTION ANALYSIS

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JOURNAL OF HEALTH ECONOMICS 1992年第3期11卷 297-314页

作者： JOYCE, T RACINE, AD MOCAN, N CUNY NEW YORKNY 10021 COLUMBIA UNIV NEW YORKNY 10027 UNIV COLORADO DENVERCO 80202

We use a pooled time-series cross-section of live births in New York City between 1980 and 1989 to investigate the dramatic rise in low birthweight, especially among Blacks, that occurred in the mid 1980s. After controlling for other risk factors, we estimate that the number of excess low birthweight births attributable to illicit substance abuse over this period ranged from approximately 1,482 to 3,359. The increase represents between 3.2 and 7.3% of all LBW over the period resulting in excess neonatal admission costs of between $18 and $41 million.

关键词：非洲裔美国人/统计学和数值数据卡方分布横断面研究欧洲大陆世系人群/统计学和数值数据卫生保健费用/统计学和数值数据西班牙裔美国人/统计学和数值数据医院市区/经济学婴儿出生时低体重重症监护病房新生儿/经济学纵向研究模型统计学纽约市/流行病学回归分析社会经济因素物质相关性障碍/并发症物质相关性障碍/经济学物质相关性障碍/流行病学女(雌)性人类婴儿新生妊娠

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