Neighborhood socioeconomic and racial disparities in angiography and coronary revascularization: the ARIC surveillance study

Ann Epidemiol. 2012 Sep;22(9):623-9. doi: 10.1016/j.annepidem.2012.06.100. Epub 2012 Jul 17.

Abstract

Purpose: Disparities in the receipt of angiography and subsequent coronary revascularization have not been well-studied.

Methods: We estimated prevalence ratios and 95% confidence intervals (PR, 95% CIs) for the association between neighborhood-level income (nINC) and receipt of angiography; and among those undergoing angiography, receipt of revascularization procedures, among 9941 hospitalized myocardial infarction patients under epidemiologic surveillance by the Atherosclerosis Risk in Communities Study (1993-2002).

Results: In analyses by tertile of nINC controlling for age, study community, gender, and year, compared with white patients from high nINC areas, black patients from low nINC (0.60, 0.54-0.66) and medium nINC (0.70, 0.60-0.78) areas, as well as white patients from low nINC areas (0.83, 0.75-0.91) were less likely to receive angiography, whereas black patients from high nINC and white patients from medium nINC areas were not. Associations were attenuated, but persisted, after we controlled for event severity, medical history, receipt of Medicaid, and hospital type. Compared with high nINC white patients, black patients were less likely, and white patients were as likely, to undergo cardiac revascularization, given receipt of an angiogram.

Conclusions: Black and lower nINC patients were less likely to undergo angiography than were white patients and those from higher nINC areas. Among those receiving angiography, race, but not nINC, gradients persisted.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • African Continental Ancestry Group / statistics & numerical data*
  • Aged
  • Comorbidity
  • Confidence Intervals
  • Coronary Angiography / statistics & numerical data*
  • European Continental Ancestry Group / statistics & numerical data*
  • Healthcare Disparities / ethnology*
  • Healthcare Disparities / statistics & numerical data
  • Humans
  • Medicaid / statistics & numerical data
  • Middle Aged
  • Myocardial Infarction / diagnostic imaging*
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / surgery*
  • Myocardial Revascularization / statistics & numerical data*
  • Prevalence
  • Smoking / epidemiology
  • Socioeconomic Factors
  • United States / epidemiology