Access to coronary artery bypass surgery by race/ethnicity and gender among patients who are appropriate for surgery

Med Care. 1999 Jan;37(1):68-77. doi: 10.1097/00005650-199901000-00010.


Objective: The study sought to determine if there were race/ethnicity or gender differences in access to coronary artery bypass graft (CABG) surgery among patients who have been designated as appropriate and as necessary for that surgery according to the RAND methodology.

Methods: RAND appropriateness and necessity criteria were used to identify a race/gender stratified sample of postangiography patients who would benefit from coronary artery bypass graft surgery. These patients were tracked for 3 months to determine if they had undergone coronary artery bypass graft surgery in New York State. Subjects were a total of 1,261 postangiography patients in eight New York hospitals in 1994 to 1996. Measures included percentages of patients for whom coronary artery bypass graft surgery was appropriate and necessary undergoing surgery by race/ethnicity and gender, as well as multivariate odds ratios for race/ethnicity and gender.

Results: After controlling for age, payer, number of vessels diseased, and presence of left main disease, African-American and Hispanic patients were found to be significantly less likely to undergo coronary artery bypass graft surgery than white non-Hispanic patients (respective odds ratios 0.64 and 0.60). When "necessity" was used as a criterion instead of "appropriateness," significant differences in access for African-American patients remained. The gatekeeper physician recommended surgery only 10% of the time that patients did not undergo "appropriate" coronary artery bypass graft surgery, and this percentage did not vary significantly by race/ethnicity or gender of the patient.

Conclusions: Even after controlling for appropriateness and necessity for coronary artery bypass graft surgery in a prospective study, African-American patients had significant access problems in obtaining coronary artery bypass graft surgery. These problems appeared not to be related to patient refusals.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Black or African American / statistics & numerical data*
  • Coronary Angiography
  • Coronary Artery Bypass / statistics & numerical data*
  • Female
  • Health Services Accessibility / standards
  • Health Services Accessibility / statistics & numerical data*
  • Health Services Research
  • Hispanic or Latino / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • New York
  • Patient Selection
  • Practice Guidelines as Topic
  • Prospective Studies
  • Referral and Consultation / statistics & numerical data
  • Severity of Illness Index
  • Sex Factors
  • White People / statistics & numerical data*