Racial, Gender Disparity Exists in Access to High-quality Cardiac Surgery

WESTPORT, CT (Reuters Health) – Not only are non-white patients and women less likely to undergo coronary artery bypass surgery than white men for the same indications, a study conducted in New York State shows that they are also less likely to receive care from high-quality cardiac surgeons.

Dr. Dana B. Mukamel, of the University of Rochester Medical Center, and associates evaluated data for 11,296 patients who underwent cardiac artery bypass graft surgery in New York in 1996. The investigators also obtained “risk-adjusted mortality rates” (RAMR) for each surgeon from the 1996 New York State Cardiac Surgery Report. Their findings appear in the November issue of the American Journal of Public Health.

The investigators observed a significant regional variation in RAMRs for cardiac surgeons, ranging from 2.07% to 3.25% across the state.

Non-whites enrolled in either fee-for-service plans or in health maintenance organizations (HMOs) were treated by surgeons with higher RAMRs than were their white counterparts. The researchers calculate that “the race effect translates into a mortality rate that is 5.4% higher for surgeons treating non-white fee-for-service enrollees and 11.7% higher for surgeons treating non-white HMO enrollees.”

Similar observations were made regarding women compared with men.

Dr. Mukamel’s group suggests that “disadvantaged minorities are more likely to face barriers to accessing…information” regarding surgeons’ RAMR. Also, minorities may be more sensitive to differences in prices among surgeons, where surgeons with better RAMRs charge more and are located in more affluent markets.

Am J Public Health 2000;90:1774-1777