摘要：Objectives. We sought to examine whether physician recommendations for cardiac revascularization vary according to patient race. Methods. We studied patients scheduled for coronary angiography at 2 hospitals, one public and one private, between November 1997 and June 1999. Cardiologists were interviewed regarding their recommendations for cardiac resvacularization. Results. African American patients were less likely than Whites to be recommended for revascularization at the public hospital (adjusted odds ratio [OR] = 0.31; 95% confidence interval [CI] = 0.12, 0.77) but not at the private hospital (adjusted OR = 1.69; 95% CI = 0.69, 4.14). Conclusions. Physician recommendations for cardiac revascularization vary by patient race. Further studies are needed to examine physician bias as a factor in racial disparities in cardiac care and outcomes. Cardiovascular diseases are still a major cause of mortality and morbidity in the developed world, including the United States. 1– 3 Thirteen million Americans have been diagnosed with coronary artery disease, and more than 7 million have had myocardial infarctions. 1 Each year, more than 1 million Americans experience a myocardial infarction. 1 Moreover, cardiovascular disease is the leading cause of death among both White and African Americans; in fact, death rates from cardiovascular causes among African Americans are among the highest in the industrialized world. 2, 4, 5 In addition to early prevention and recognition, one of the primary strategies for reducing cardiovascular deaths has been the use of cardiac revascularization. Improved technology for assessing cardiovascular diseases, combined with the fact that about half of all myocardial infarctions occurring in the United States each year represent recurrent infarctions, has led to the rise of cardiac revascularization rates in the past 2 decades. 5 For example, between 1987 and 1990 alone, rates of percutaneous transluminal angioplasty (PTCA) and coronary artery bypass grafting (CABG) increased by 55% and 18%, respectively, in the United States. 6 The increased use of these procedures has resulted in lower short- and long-term mortality and morbidity rates among patients with coronary artery disease. 6 Given the similar burden of cardiovascular diseases in African Americans and Whites and the increasing safety and efficacy of revascularization, one would expect relatively little racial/ethnic disparity in the use of this treatment. However, numerous studies have reported widespread racial disparities in cardiac revascularization rates, particularly between African American and White patients. 7– 11 This racial/ethnic disparity has generated concern given that cardiovascular diseases cause disproportionate mortality and morbidity in the African American community, 2, 12– 14 which is one of the reasons why cardiovascular diseases are included in the 6 key health conditions targeted in the national effort to eliminate racial/ethnic disparities in health care by 2010. 15 As is the case with disparities in other health conditions, the reasons for racial/ethnic disparities in cardiac revascularization rates remain poorly understood, but they have been hypothesized to include factors at the patient, provider, and system levels. Relatively few studies have examined provider or system factors that may contribute to these disparities. In one recent study conducted by Hannan et al., physicians were less likely to recommend revascularization to African American patients than to White patients, even in the case of patients who had a clinically indicated need for revascularization and who were similar in terms of disease status. 16 The authors suggested that provider incentives may play a role in this disparity and called for further investigation. We report here a study that examined physician recommendations for revascularization among African American and White patients who had coronary angiographies (cardiac catheterization) at 2 health care facilities.
