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Ann Thorac Surg 2001;71:405-406
© 2001 The Society of Thoracic Surgeons

Editorial

The challenges of health disparity and cardiovascular outcomes

Rosalyn P. Scott, MD, MSHAa

a Department of Surgery, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA

Address reprint requests to Dr Scott, Department of Surgery, Charles R. Drew University of Medicine and Science, 1621 E 120th St, Los Angeles, CA 90059
e-mail: rozscott@gte.net

Risk and operative mortality after coronary artery bypass grafting (CABG) have traditionally been characterized in terms of nondemographic, nonsocioeconomic, biological variables. More recently, increasing attention has been directed to the impact of sex on the pathology, clinical presentation, diagnosis, and treatment of coronary artery disease. As a result, sex has been definitively identified as an important predictor of cardiovascular surgical outcomes, including operative mortality after CABG.

In this issue, Hartz and associates have extended previous analyses of The Society of Thoracic Surgeons National Database records for 1994 through 1996 to delineate the influence of race alone and in combination with sex on the 30-day operative mortality after CABG. In their study, both race and sex were independent predictors of adverse outcome. However, because of the relatively small number of records within each nonwhite (to use the terminology of Hartz and coworkers) racial group, all these groups were classified as nonwhite for the purpose of risk modeling. Among the nonwhite patients studied, more than 50% were African-American. The study also demonstrated that proportionally more nonwhite women than white women underwent CABG and that the nonwhite patients were younger, had more advanced disease, and were diabetic and in renal failure more often than white patients at the time of operation.

The critical inference made in this study, that all nonwhite populations are the same, may have statistical convenience, but it is not substantiated by what is known about health outcomes. All nonwhite racial groups—Black, Asian/Pacific Islander, American Indian/Alaskan Native, and ethnic groups such as Hispanic—are considered together in one racial categorization by Hartz and coauthors. These categories correspond to the race and ethnic standards for federal statistics and administrative reporting.

The current notions of "race" and "ethnicity" have evolved in the . . . [Full Text of this Article]




This article has been cited by other articles:


Home page
 Ann. Thorac. Surg.Home page
R. P. Scott and K. C. Heslin
Historical perspectives on the care of african americans with cardiovascular disease
Ann. Thorac. Surg., October 1, 2003; 76(4): S1348 - 1355.
[Full Text] [PDF]


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