Early results of Massachusetts healthcare reform on racial, ethnic, and socioeconomic disparities in cardiovascular care

Michelle A Albert; John Z Ayanian; Treacy S Silbaugh; Ann Lovett; Fred Resnic; Aryana Jacobs; Sharon-Lise T Normand

doi:10.1161/CIRCULATIONAHA.113.005231

Early results of Massachusetts healthcare reform on racial, ethnic, and socioeconomic disparities in cardiovascular care

Circulation. 2014 Jun 17;129(24):2528-38. doi: 10.1161/CIRCULATIONAHA.113.005231. Epub 2014 Apr 11.

Authors

Michelle A Albert¹, John Z Ayanian², Treacy S Silbaugh², Ann Lovett², Fred Resnic², Aryana Jacobs², Sharon-Lise T Normand²

Affiliations

¹ From the Divisions of Cardiovascular Medicine and Preventive Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (M.A.A., F.R.); Division of General Medicine, Brigham and Women's Hospital, Boston, MA (J.Z.A.); Department of Health Care Policy, Harvard Medical School, Boston, MA (J.Z.A., A.L., S.T.N.); Lahey Clinic, Lahey, MA (F.R.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.T.N.); Institute of Healthcare Policy, University of Michigan, Ann Arbor (J.Z.A.); and Division of Cardiovascular Medicine at Howard University and Howard University Hospital, Washington, DC (A.J.). michelle.albert@howard.edu.
² From the Divisions of Cardiovascular Medicine and Preventive Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (M.A.A., F.R.); Division of General Medicine, Brigham and Women's Hospital, Boston, MA (J.Z.A.); Department of Health Care Policy, Harvard Medical School, Boston, MA (J.Z.A., A.L., S.T.N.); Lahey Clinic, Lahey, MA (F.R.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.T.N.); Institute of Healthcare Policy, University of Michigan, Ann Arbor (J.Z.A.); and Division of Cardiovascular Medicine at Howard University and Howard University Hospital, Washington, DC (A.J.).

Abstract

Background: Insured adults receive invasive cardiovascular procedures more frequently than uninsured adults. We examined the impact of healthcare reform in Massachusetts on use of coronary revascularization procedures and in-hospital and 1-year mortality by race/ethnicity, education, and sex.

Methods and results: Using hospital claims data, we compared differences in coronary revascularization rates (coronary artery bypass grafting or percutaneous coronary intervention) and in-hospital mortality by race/ethnicity, education, and sex among Massachusetts residents aged 21 to 64 years hospitalized with a principal discharge diagnosis of ischemic heart disease before (November 1, 2004, to July 31, 2006) and after (December 1, 2006, to September 30, 2008) reform; 1-year mortality was calculated for those undergoing revascularization. Adjusted logistic regression assessed 24 216 discharges before reform and 20 721 discharges after reform. Blacks had 30% lower odds of receiving coronary revascularization than whites in the prereform period. Compared with whites in the postreform period, blacks (odds ratio=0.73; 95% confidence interval, 0.63-0.84) and Hispanics (odds ratio= 0.84; 95% confidence interval, 0.74-0.97) were less likely and Asians (odds ratio=1.29; 95% confidence interval, 1.01-1.65) were more likely to receive coronary revascularization. Patients living in more educated communities, men, and persons with private insurance were more likely to receive coronary revascularization before and after reform. Compared with the prereform period, the adjusted odds of in-hospital mortality were higher in patients living in less-educated communities in the postreform period. No differences in 1-year mortality by race/ethnicity, education, or sex for revascularized patients were observed before or after reform.

Conclusions: Reducing insurance barriers to receipt of coronary revascularization procedures has not yet eliminated preexisting demographic and educational disparities in access to these procedures.

Keywords: coronary; ethnicity; gender; race; socioeconomic status.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Coronary Artery Bypass / mortality
Coronary Artery Bypass / statistics & numerical data*
Coronary Artery Disease / ethnology*
Coronary Artery Disease / mortality
Coronary Artery Disease / therapy
Educational Status
Ethnicity / statistics & numerical data*
Female
Health Care Reform / statistics & numerical data
Healthcare Disparities / statistics & numerical data*
Hospital Mortality
Humans
Insurance, Health / statistics & numerical data
Male
Massachusetts / epidemiology
Middle Aged
Percutaneous Coronary Intervention / mortality
Percutaneous Coronary Intervention / statistics & numerical data*
Prevalence
Socioeconomic Factors
Young Adult

Abstract

Publication types

MeSH terms

Grants and funding