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Ann Thorac Surg 2004;78:18-24
© 2004 The Society of Thoracic Surgeons

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Original article: cardiovascular

Explaining disparities in access to high-quality cardiac surgeons

^a Excellus BlueCross BlueShield, Rochester, New York, USA
^b Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA

Accepted for publication January 28, 2004.

^* Address reprint requests to Dr Mukamel, University of California, Irvine, Health Policy Research, 100 Theory, Suite 110, Irvine CA 92697-5800, USA
e-mail: dmukamel{at}uci.edu

BACKGROUND: Racial disparities in access to coronary artery bypass graft (CABG) surgery are well documented. Recent evidence shows that even when patients receive CABG surgery, racial minorities are more likely to be treated by lower quality providers.

METHODS: New York State (NYS) hospital discharge data for 1996 and 1997 for patients undergoing CABG surgery were combined with risk-adjusted mortality rates for cardiac surgeons calculated by the NYS Department of Health. Statistical analysis was performed to determine the relationship between patients' race and the quality of the surgeon performing the CABG, as measured by the surgeon's risk-adjusted mortality rate, after controlling for patient characteristics such as comorbidities and socioeconomic status; the hospital where the surgery was performed; and the number of surgeries the surgeon performed over a 3-year period.

RESULTS: African Americans and Asian/Pacific Islanders are treated by surgeons with higher risk-adjusted mortality rates compared with whites. This association does not appear to be a result of inadequate risk adjustment. It is explained to some degree by the hospital to which these patients are admitted, and to a lesser degree by (1) the education and income level in the patient's zipcode of residence and (2) being treated by a low-volume surgeon. After controlling for these factors, race continues to be associated with treatment by a surgeon with a higher risk-adjusted mortality rate.

CONCLUSIONS: Efforts to achieve the "Healthy People 2010" goals of eliminating health disparities should address not only access to care, but also access to high-quality care.

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