Unequal Treatment Confronting Racial and Ethnic Disparities in Health Care (2003) / Chapter Skim
Currently Skimming:
Appendix B: Literature Review
Appendix B: Literature Review
Pages 285-383
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 285... ...
To assess the evidence regarding racial and ethnic differences in health care, the committee conducted literature searches via PUBMED and MEDLINE databases to identify studies examining racial and ethnic differences in medical care for a variety of disease categories and clinical services. Searches were performed using combinations of following keywords: · Race, racial, ethnicity, ethnic, minority/ies, groups, African American, Black, American Indian, Alaska Native, Native American, Asian, Pacific Islander, Hispanic, Latino.
|
From page 286... ...
and health care access, as well as publications that were editorials, letters, published in a foreign language, were non-empirical, or studies that controlled for race or ethnicity; and · Inclusion only of studies whose primary purpose was to examine variation in medical care by race and ethnicity, contained original findings, and met generally established principles of scientific research (e.g., studies that stated a clear research question, provided a detailed description of data sources, collection, and analysis methods, included samples large enough to permit statistical analysis, and employed appropriate statistical measures)
|
From page 287... ...
Studies that met the committee's "threshold" criteria are summarized in Table B-1. As a "second level" analysis of the quality of evidence regarding racial and ethnic disparities in cardiovascular care, the committee identified a subset of studies that permit a more detailed analysis of the relationship between patient race or ethnicity and quality of care, while considering potential confounding variables such as clinical differences in presentation and disease severity.
|
From page 288... ...
One, studies using clinical data allow researchers to better assess whether disparities in care exist and are significant after potential confounding factors such as clinical variation and the appropriateness of intervention are taken into account, but these studies often are limited to small patient samples in one or only a few clinical settings, therefore sacrificing statistical power and potentially underestimating the role of institutional variables as contributing to healthcare disparities. Second, assessments of racial and ethnic differences in patients' clinical outcomes following intervention must be made with caution.
|
From page 289... ...
A1most all studies found that adjustment for one or more confounding factors reduced the magnitude of unadjusted racial and ethnic differences in care. Among the five studies that collected data prospectively, however, all found racial and ethnic disparities remained after adjustment for confounding factors.
|
From page 290... ...
an urban hospital. Bernabei, Gambassi, Assessed adequacy of pain 13,625 cancer patients (12,038 Lapane et al., 1998 management among elderly white, 1,041 African Ameri and minority cancer patients can, 163 Hispanic, 107 Asian, admitted to nursing homes.
|
From page 291... ...
, as assessed by self report and independent raters, received no pain medication. After adjustment, African Americans had disease severity (e.g., ex- 63% greater probability of being plicit terminal prognosis)
|
From page 292... ...
with recurrent or metastatic cancer at 9 university cancer centers, 17 community hospitals and practices, and 4 centers that primarily treat minority patients. 454 (314 white, 37 Asian, 73 Hispanic, 30 African American)
|
From page 293... ...
narcotic prescribed among Asians, blacks, Hispanics, and whites (F = 7.352; p < 0.01~. Whites and African Americans were prescribed more narcotic than Hispanics and Asians.
|
From page 294... ...
cat Center between 1992-1993. Todd, Samaroo, and Assessed ethnic differences in 139 patients (108 white, 31 Hoffman, 1993 receipt of emergency depart- Hispanic)
|
From page 295... ...
1.35 to 3.32, p = 0.003~. After simulta Independent variables neously controlling for covariates Hispanic ethnicity was strongest predictor of no analgesia (odds ratio = 7.46, 95% CI 2.22 to 25.04, p < 0.01)
|
From page 296... ...
between 9/93 and 12/93. Zoratti, Havstad, Assessed racial/ethnic differ- 464 African-American and Rodriguez et al., 1998 ences in treatment for asthma 1,609 white patients treated in a managed care setting.
|
From page 297... ...
Among only low income patients, African Americans were more likely to be treated in emergency rooms than whites, al though no significant differences were found in access to specialty care and hospitalization rates. After adjusting for age, gender, marital status and income, African Americans were more likely to use oral corticosteroids (p = 0.026)
|
From page 298... ...
Receipt of surgery or radiation therapy among white and African-American women with cervical cancer. 251 patients (157 white, 94 minority [largely African American]
|
From page 299... ...
Whites were characteristics on risk of more likely than African Americans, -Racial/ethnic groups other than African American and white not examined. -Retrospective study.
|
From page 300... ...
procedures were used to diagnose colorectal disease. Dominitz, Samsa, Assessed racial/ethnic differ- 3,176 patients (17.9% African Landsman, and ences in receipt of treatment American)
|
From page 301... ...
-Racial/ethnic groups other than white and African Logistic regression to predict No significant racial differences found -Racial/ethnic likelihood of surgical resee- in rates of receipt of surgical resection groups other than lion, chemotherapy, or (70% among blacks, 73% among whites; African American radiation therapy, after odds ratio = 0.92, 95% CI 0.74 to 1.15) , and white not adjusting for patient demo graphic characteristics, comorbidities, distant me tastases, and tumor location.
|
From page 302... ...
Assessed variation by race/ ethnicity in rates of radical prostatectomy among male 246 women (89 African American, 157 white) who sought care for breast cancer in one of three health maintenance organizations (HMOs)
|
From page 303... ...
When metastasis was recorded black patients with primary tumor were 27% less likely to received a major colorectal therapeutic procedure (odds ratio = 0.726, p < 0.05~. -Racial/ethnic groups other than African American and white not examined.
|
From page 304... ...
1,606 prostate cancer patients (7.5% African American, 92.5% white) who were active duty personnel, dependents, or retirees eligible for care in the military medical system.
|
From page 305... ...
. -Racial/ethnic groups other than white and African American not examined.
|
From page 306... ...
Bell and Hudson, 2001 Racial and gender differences Analysis of 379 records of in emergency room treatment patients (229 white, 150 of chest pain. African American)
|
From page 307... ...
Models Echo: African Americans more likely tested main effects of clinic, to receive Echo (adjusted odds ratio = gender, race, and insurance, 0.5927, 95% CI 0.377 to 0.931~. and interactions between gender and race and be- Time tofirst EKG: African-American tween insurance and race.
|
From page 308... ...
went coronary angiography in 1991 and 1992. Watson, Stein, Influence of race and gender Prospective study of 838 Dwamera et al., 2001 on use of invasive procedures patients (443 white men, 264 in patients with acute myo- white women, 79 African cardial infarction (AMI)
|
From page 309... ...
adjusted odds than African American groups other than procedures that were ap- men of receiving inappropriate PTCA African American propriate, uncertain, or (odds ratio = 2.42, 95% CI 1.02 to not examined. inappropriate.
|
From page 310... ...
Patient medical records were also reviewed. Daumit, Hermann, Ethnic differences in use of 4,987 patients (3,152 white, Coresh, and Powe, cardiovascular procedures in 1,835 African American)
|
From page 311... ...
Logistic regression also used to identify receipt of proce dure during follow-up. Cox proportional hazards After adjustment, odds of having a cardiac procedure at baseline were nearly three times greater for white patients than for African-American patients (odds ratio = 2.92, 95% CI 2.04 to 4.18~.
|
From page 312... ...
Leape, Hilborne, Bell et Assessed use of CABG or al., 1999 PCTA for patients for whom revascularization procedures 631 patients (44% white, 27% African American, 29% Hispanic)
|
From page 313... ...
Odds ratios: Logistic regression to assess No significant variations found in rates -Moderate sample of revascularization among African- size. American patients, (72%)
|
From page 314... ...
Canto, Herman, Racial/ethnic differences in 275,046 consecutive AMI Williams, Sanderson presenting characteristics, patients (86% white, 3% et al., 1998 treatment, and outcomes in Hispanic, 1% Asian and patients with myocardial Pacific Islander, < 1% Native infarction. American)
|
From page 315... ...
Logistic regression to assess Hispanics were as likely as whites to factors predicting acute receive thrombolytic therapy. Asian reperfusion strategies, and Pacific Islanders were less likely to invasive cardiac procedures, receive this therapy (odds ratio = 0.84, and mortality.
|
From page 316... ...
Assessed racial/ethnic differences in use of coronary angioplasty and bypass surgery among patients with Patients from National Registry of Myocardial Infarction 2 (NRMI-2~. 275,046 patients included (86% white, 6% black)
|
From page 317... ...
Logistic regression models to predict the likelihood that a patient would undergo angioplasty or Black patients were less likely to receive intravenous thrombolytic -NRMI-2 not ran therapy (odds ratio = 0.76, 95% CI domized sample of 0.71 to 0.80) , coronary arteriography patients.
|
From page 318... ...
Assessed gender and ethnic differences in receipt of percutaneous transluminal coronary angioplasty (PTCA) and aortocoronary bypass surgery (ACES)
|
From page 319... ...
Independent vari ables included age, sex, severity of disease, other clinical and co-morbid factors, and insurance. survival benefit of surgery also revealed racial differences; among patients expected to survive more than one year, 42% of African Americans underwent surgery, compared to 61% of whites (p < 0.001~.
|
From page 320... ...
. Allison, Kiefe, Centor Assess variations in use of Retrospective medical record et al., 1996 medications among African- review of 4,052 patients (3,542 American and white Medi- white, 510 African American)
|
From page 321... ...
or thrombolytic therapy (b/w odds ratio = 0.5, 95% CI 0.3 to 0.7~. -Racial/ethnic groups other than African American and white not assessed.
|
From page 322... ...
. Carlisle et al., 1995 Assessed use of coronary 131,408 patients (89,781 white, artery angiography, bypass 16,509 African American, graft surgery, and angio- 19,218 Latino, and 5,900 Asian)
|
From page 323... ...
Series of logistic regression African Americans were less likely models to assess relation- than whites to receive bypass graft ship between use of inva- (odds ratio = 0.62, 95% CI 0.56 to sive procedures and ethnic- 0.69) and angioplasty (odds ratio = ity, controlling for primary 0.80, 95% CI 0.72 to 0.88~.
|
From page 324... ...
National Hospital Discharge Survey records of 10,348 patients (9,289 white, 159 African American) hospitalized with AMI.
|
From page 325... ...
Logistic regression analysis Significant differences by race and adjusting for age, type of gender were found after statistical health insurance, hospital adjustment and patient matching size and type, region, in- procedure. With white males as the hospital mortality, and referent, black men were less likely to hospital transfer rates to receive catherterization (odds ratio = assess differences in rates of 0.67, 95% CI 0.51 to 0.87)
|
From page 326... ...
Ayanian, Udvarhelyi, Assessed racial differences in 27,485 Medicare Part A en Gatsonis et al., 1993 rates of coronary revascular- rollees (26,389 white, 1,096 ization following angiogra- African American) who phy and relationship of these underwent inpatient coronary differences to hospital angiography in 1987.
|
From page 327... ...
Logistic regression analyses African Americans were less likely than -Racial/ethnic to predict revascularization, whites to receive a revascularization groups other than controlling for age, sex, procedure (w/b adjusted odds ratio = African American region, Medicaid eligibility, 1.78, 95% CI 1.56 to 2.03~. Greater use of and white not principal diagnosis, second- revascularization occurred in public, examined.
|
From page 328... ...
Oddone, Homer, Racial differences in use of 803 patients (389 African Sloane et al., 1999 carotid artery imaging in American, 414 white) hospi Veterans Affairs Medical talized in one of four VA Centers.
|
From page 329... ...
. Logistic regression to deter- African American patients were less -Retrospective mine adjusted odds ratios likely to have an imaging study of study reviewing for receiving any carotid their carotid arteries (22% vs.
|
From page 330... ...
Children's Health Care Weech-Maldonado Parents' ratings and reports Reponses for over 9,000 et al., 2001 of pediatric care under Med- children (842 Hispanic, 1,344 icaid Managed Care by race, African American, 131 Asian, ethnicity, and primary 330 American Indian, 6,329 language. white, 111 other)
|
From page 331... ...
rotid artery stenosis. RR of carotid endarterectomy for whites compared to African Americans was 1.34 (95% CI 0.70 to 2.53~.
|
From page 332... ...
332 TABLE B-1 Continued UNEQUAL TREATMENT Children's Health Care Source Procedure/Illness Sample Analyses Furth et al., 2000 Access to kidney transplant 3,284 patients < 20 years of list. age (1,122 black, 2,162 white)
|
From page 333... ...
-No controls for use Race/ethnicity, insurance of professional status, provider training, interpreter or ad patient care setting, and hoc interpreter triage category, patient age, -Single site patient vital signs, included in models to isolate effect of language barrier. Logistic regression to esti- Caucasians were twice as likely to mate the probability of receive psychotropic prescriptions psychotropic medication compared with African Americans use as a function of race and after adjusting for geographic region region.
|
From page 334... ...
334 TABLE B-1 Continued UNEQUAL TREATMENT Children's Health Care Source Procedure/Illness Sample Analyses tory care visit in 1987. Data were obtained from the Household Component of the National Medical Expenditure Survey (NMES)
|
From page 335... ...
The addition of health factors, and number of physician visits did not change these relationships (odds ratio = 0.601, p < 0.001, odds ratio = 0.697, p < 0.01 respectively)
|
From page 336... ...
. Emergency Services Lowe et al., 2001 Assessed racial differences in 15,578 African-American and denial of authorization for white patients who sought emergency department (ED)
|
From page 337... ...
Logistic regression to assess 19% of African Americans, 13.2% of independent effect of race/ whites and 11.3% of Hispanic pa ethnicity on ED use. tients reported two or more previ ous ED visits (in preceding three months)
|
From page 338... ...
338 TABLE B-1 Continued UNEQUAL TREATMENT Emergency Services Source Procedure/Illness Sample Analyses Eye Care Devgan, Yu, Kim, and Surgical treatment of glau- Retrospective cohort analysis Coleman, 2000 coma in African-American of 30,495 African-American Medicare beneficiaries. and 160,792 white patients over 65 years of age undergo ing argon laser trabeculo plasty or trabeculectomy surgery between 1991 and 1994.
|
From page 339... ...
. After adjusting for age, insurance status, regular source of care, and transportation difficulties, ethnicity was not significantly associated with two or more ED visits in the preceding three months (adjusted odds ratio for Hispanics compared with African Americans 1.48, 95% CI 0.95 to 2.3 and adjusted odds ratio for Hispanics compared with whites was 1.22, 95% CI 0.74 to 2.00~.
|
From page 340... ...
prospectively compiled clinical data from records and interview, for the year before the new proce dure was introduced and the first four years of use of the procedure (1991-1995~.
|
From page 341... ...
Predictors included likely as white patients to undergo African American race, age, marital status, the laparoscopic procedure (adjusted not examined. hospital geographic loca- odds ratio = 0.74, 95% CI 0.66 to 0.83~.
|
From page 342... ...
Bennett, Homer, Assessed quality of care for Retrospective chart review of Weinstein et al., 1995 pneumocyctis carinii pneu- a cohort of 627 VA patients mania (PCP) among white, and 1,547 non-VA patients Hispanic and African- with treated or cytologically American patients with HIV confirmed PCP who were receiving care in either hospitalized from 1987 to Veterans Administration 1990.
|
From page 343... ...
African-American patients were significantly less likely than whites to receive antiretroviral therapy (odds ratio = 0.59, 95% CI 0.38 to 0.93) or PCP prophylaxis (odds ratio = 0.27, 95% CI 0.13 to 0.56~.
|
From page 344... ...
344 TABLE B-1 Continued UNEQUAL TREATMENT Maternal and Infant Health Source Procedure/Illness Sample Analyses Aron, Gordon, DiGiuseppe et al., 2000 Cesarean delivery rates. 25,697 women (19,996 white, 5,701 nonwhite)
|
From page 345... ...
logistic regression deliver via cesarean (odds ratio = 1.34, used to yield odds ratios for 95% CI 1.14 to 1.57, p < 0.001~. Analy cesarean delivery in non white patients relative to whites and for patients with government insurance or who were uninsured rela tive to patients with com mercial insurance.
|
From page 346... ...
346 TABLE B-1 Continued UNEQUAL TREATMENT Maternal and Infant Health Source Procedure/Illness Sample Analyses Braveman, Egerter, Cesarean delivery rates. 217,461 singleton first live Edmonston, and births (15,529 African Ameri Verdon, 1995 can, 19,142 foreign-born Asian, 62,303 foreign-born Latina, 26,802 U.S.-born Latina, 93,685 white)
|
From page 347... ...
African American Ultrasonography was received by and white not black women slightly less frequently examined. than white women (adjusted RR = -Administrative data.
|
From page 348... ...
African American, 19,330 white) age 60 and older hospitalized for psychiatric diagnoses treated in Depart ment of Veterans Affairs inpatient facilities in 1994.
|
From page 349... ...
-Relatively few Hispanics in sample. Bivariate tests between 44% of whites and 27.8% blacks -Racial/ethnic those who did and did not received antidepressant treatment groups other than receive antidepressants and within 30 days of 1st indicator of African Americans between racial categories.
|
From page 350... ...
Chung, Mahler, and Inpatient psychiatric treatment. 164 adults (76 African Ameri Kakuma, 1995 can, 88 white)
|
From page 351... ...
whites to side effects of Tricyclics and therefore should be more likely to receive SSRIs. More psychiatric medications were -Small number of prescribed to African Americans than minorities.
|
From page 352... ...
352 TABLE B-1 Continued UNEQUAL TREATMENT Mental Health Source Procedure/Illness Sample Analyses Padgett, Patrick, Burns, and Schlesinger, 1994 Use of inpatient mental health services. 7,768 persons insured by Blue Cross and Blue Shield Association's Federal Employees Plan in 1983, who had at least one inpatient psychiatric day and random sample of 5,000 nonusers of mental health services.
|
From page 353... ...
Logistic regression to assess Black patients were more likely to odds of amputation and surgery for black relative to white patients, controlling for case-mix, region, and hospital characteristics. undergo all forms of amputation than were white patients (unadjusted odds ratio = 1.47 to 2.24)
|
From page 354... ...
354 TABLE B-1 Continued UNEQUAL TREATMENT Peripheral Vascular Disease Source Procedure/Illness Sample Analyses Pharmacy Morrison, Wallenstein, Natale et al., 2000 Differences in white and nonwhite neighborhoods in pharmacy stocking of opioid analgesics. Random sample of 30% (347)
|
From page 355... ...
African American, Asian) , plantation (odds ratio = 0.46, (95% CI -Potential bias in gender, living situation, 0.24 to 0.91~.
|
From page 356... ...
356 TABLE B-1 Continued UNEQUAL TREATMENT Physician Perceptions Source Procedure/Illness Sample Analyses June 1997 to June 1998. Response rate 53%.
|
From page 357... ...
0.003~. Male physicians prescribed -No controls for higher doses to white patients than to physician prescrib African Americans, while female ing habits.
|
From page 358... ...
618 patient encounters at eight New York state hospitals. Patients Perceptions Doescher et al., 2000 Racial and ethnic differences 32,929 patients surveyed in patients' perceptions of through the Community their physicians (trust and Tracking Survey, a nationally satisfaction)
|
From page 359... ...
Logistic regression analysis Physicians were less likely to recom- -Representativeness to assess the effects of mend cardiac catheterization for of sample: partici "patient" race and gender, women than men (odds ratio = 0.60, pants recruited at while controlling for physi- 95% CI 0.4 to 0.9) and African Ameri- national meeting.
|
From page 360... ...
test. Rehabilitative Services Harada, Chun, Chui, Assessed sociodemographic Records of 187,900 hip frac and Pakalniskis, 2000 and clinical characteristics lure patients (94% white, 4% associated with use of physi- African American, 3% cat therapy (PT)
|
From page 361... ...
found in the likelihood of use of therapy (RR = 1.06, 95% CI 0.89 to 1.27) or time to initiate therapy (African Americans = 6.6 days, whites = 7.4, p = 0.42~.
|
From page 362... ...
with acute hip fracture. Renal Care and Transplantation Ayanian, Cleary, Effect of patient preferences 1,392 patients (384 African Weissman, and on access to renal American women, 354 white Epstein, 1999 transplantation.
|
From page 363... ...
Logistic regression 79% of white women, p = 0.13; 80.7% examined. to estimate: 1)
|
From page 364... ...
364 TABLE B-1 Continued UNEQUAL TREATMENT Renal Care and Transplantation Source Procedure/Illness Sample Analyses Kasiske, London, and Ellison, 1998 Barker-Cummings, McClellan, Soucie, and Krisher, 1995 Racial/ethnic differences in early placement on kidney transplantation waiting list. Use of peritoneal dialysis as initial treatment for end-stage renal disease (ESRD)
|
From page 365... ...
included being African American for hospital charac (odds ratio = 0.465, p < 0.001, refer- teristics of appro ence: white) , Hispanic (odds ratio = priateness.
|
From page 366... ...
Ethnic differences in receipt of major therapeutic procedures during hospitalization. Racial and ethnic magnitude of disparities in use of health care services from 1977 to 1996.
|
From page 367... ...
unrelated to managed care, but may -Disproportional have biased difference-in-difference enrollment of estimates, results indicate that African- African Americans American adults (DD = -2.463, p < 0.01)
|
From page 368... ...
Discharge abstract data on 1,727,086 discharges (87.9% white, 12.1% African American, 63.6% female, 36.4%
|
From page 369... ...
as potential confounds. Logistic regression to assess African Americans were less likely -Racial/ethnic independent effect of race than whites to receive major therapeu- groups other than and gender on likelihood of tic procedures in 37 of 77 (48.1%)
|
From page 370... ...
Gender and ethnic differences in hospital-based procedure utilization. Retrospective analysis of data on 7,249 hospital discharges in California between 1989 and 1990.
|
From page 371... ...
Logistic regression to White patients were more likely than -Administrative estimate likelihood of African Americans to receive kidney data. obtaining procedure as transplantation (odds ratio = 3.05, -Retrospective function of ethnicity and 95% CI 2.27 to 4.17)
|
From page 372... ...
aged 65 years or older. Phillips, Hamel, Teno et al., Assessed racial differences in use of: 1996 operation, dialysis, pulmonary artery catheterization, endoscopy, bronchos copy, and hospital charges.
|
From page 373... ...
Logistic regression to assess independent effect of race on procedure use, control ling for age, gender, educa tion, income, type insur ance, severity of illness, Black patients utilized significantly -Highly selective fewer resources than patients of other sample. races (odds ratio = 0.70, 95% CI 0.6 to -Data on SES vari 0.81~.
|
From page 374... ...
Records of nearly 300,000 Medicare recipients who underwent total knee arthroplasty between 1980 and 1988. 1986 physician claims data for 1,204,022 Medicare enrollees (1,109,954 whites and 94,068 African Americans)
|
From page 375... ...
plasty, and carotid endarterectomy. -Potential con founds such as SES African Americans were more likely than whites to receive seven services (white-black RR < 1.0, p < 0.05~.
|
From page 376... ...
seen in the general internal medicine, family medicine, and gynecol ogy practices at UCSF between January 1,1992, and November 30, 1995. Marsh, Brett, and Hormone replacement 25,203 sampled visits made by Miller, 1999 therapy (HRT)
|
From page 377... ...
-Physician recommendations or patient characteristics not assessed. Logistic regression used to While physician visit rates were equal -Racial/ethnic examine whether any previ- for black and white women, the rate ously identified racial dif- of visits per year in which HRT was ferences in HRT could be prescribed to white women (odds attributed to known con- ratio = 0.38, 95% CI 0.32 to 0.45)
|
From page 378... ...
378 TABLE B-1 Continued UNEQUAL TREATMENT Women's Health Source Procedure/Illness Sample Analyses Burns, McCarthy, Mammography. 3,187,116 women (7% black, Freund, Marwill et al., 93% white)
|
From page 379... ...
models reveal that among white women, primary care use has a sig nificant effect on use of mammogra phy: for one visit odds ratio = 2.73, 95% CI 2.70 to 2.77,for two visits odds ratio = 3.98, 95% CI 3.93 to 4.03,for three or more visits odds ratio = 4.62, CI 4.58 to 4.67. Results for black women reveal an analogous, but weaker effect: for one visit odds ratio = 1.77, CI 1.67 to 1.87,for two visits odds ratio = 2.49, CI 2.36 to 2.63,for three or more visits odds ratio = 3.15, CI 3.04 to 3.25.
|
From page 380... ...
1999 Clinical Statistical adjust- Prospective Yes ment for type of insurance Leape et al. 1999 Clinical Statistical adjust- Retrospective No and labora- ment for type of tory data insurance from medi cal records Scirica et al.
|
From page 381... ...
beta-blockers, more likely than whites to receive aspirin, but were less likely to receive thrombolytic therapy at time of arrival and were less likely to receive bypass surgery, even when only high-risk coronary anatomic subgroups were assessed. No racial differ ences in refusal rates for invasive treatment.
|
From page 382... ...
1998 Clinical Statistical adjust- Retrospective Yes ment for payor status Laouriet al. 1997 Clinical Not assessed,but Retrospective Yes and labora- patients sampled with patient tory data from both public follow-up from medi- (where patients cat records are likely insured)
|
From page 383... ...
Yes No Yes Despite less intensive use of revas cularization procedures in African Americans, long-term survival after AMI was similar to whites. Yes Yes Yes African Americans less likely than whites to receive bypass surgery, but no differences found in angio plasty.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.