Grant Summary

Grant Number
R36 HS18283-01
Grant Title
Race and cardiac catheterization use in the setting of a
PI Name
DESCRIPTION (provided by the applicant): Racial differences in the incidence, prevalence, and outcomes of cardiovascular disease in the United States are well documented. A possible contributing factor to poorer outcomes among black patients with heart disease may be lower rates of procedure use, including cardiac catheterization, compared with white patients. This hypothesis has its own series of unanswered questions. First, the accuracy of racial classification data in the majority of studies relies upon administrative data or other sources, which raises concerns of potential misclassification. The specific nature of this misclassification and its implications for reported rates of treatment and outcomes are unclear. Thus, I propose to compare patients' racial classification as documented in administrative sources vs. self-reported racial designation in the PREMIER registry, a national cohort of patients hospitalized for AMI. In addition to determining overall agreement of self vs. documented-race, correlates of concordance in racial designation will be identified, and associations of race (administrative vs. self-reported) association with treatment and outcomes will be determined and compared. Second, it is unclear whether racial variations in treatment, specifically cardiac catheterization postmyocardial infarction, reflect overtreatment of white patients, under-treatment of black patients, or a combination of processes. Thus, I will develop and validate a means for classifying patients' appropriateness of cardiac catheterization following myocardial infarction using data from the CCP, a national cohort of Medicare patients hospitalized for myocardial infarction between 1994 and 1996. Racial differences in cardiac catheterization use will be assessed overall and by patient appropriateness for cardiac catheterization to determine whether racial differences in treatment vary as a function of procedure appropriateness using hierarchical logistic regression analyses. Third, despite lower rates of treatment, elderly black patients with myocardial infarction are reported to have better outcomes, including lower mortality, than their white counterparts. It is unclear whether this pattern is limited to short-term follow-up or persists over longer follow-up. Accordingly, I will assess the long-term survival of black and white patients with myocardial infarction using patients in the CCP database, focusing on mortality and intermediate endpoints (hospitalization, development of additional cardiovascular comorbidities). The three projects are consonant with AHRQ's strategic research goals, including the identification of barriers to appropriate quality of care and assessment of health services use by an AHRQ priority population (minority patients). Further, the insights obtained from this project offer the potential to inform current AHRQ, purchaser, and provider efforts to address health and health care disparities. PUBLIC HEALTH RELEVANCE: The proposed work, an investigation of racial variations in the use of cardiac catheterization in patients with myocardial infarction, is consonant with AHRQ's research mission of understanding factors influencing access to quality health care, and addresses two priority populations, minority groups and the elderly. The proposal's three projects - rigorously evaluating the quality of race data reporting in administrative data and medical records; determining whether racial variations in cardiac catheterization use reflect overtreatment of white patients, undertreatment of black patients, or a combination of processes; and the impact of racial differences in cardiac catheterization use on long-term survival - will help inform current efforts to address racial disparities in health and health care use
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