Racial disparity in access to cardiac intensive care over 20 years

Tetyana P. Shippee, Kenneth F. Ferraro, Roland J. Thorpe

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objectives. The purposes of this article are: (1) to systematically examine racial disparities in access to and use of cardiac care units (CCUs) in acute-care hospitals; and (2) to assess racial differences in post-hospital mortality following CCU stays. Design. Data from the National Health and Nutrition Examination Survey I: Epidemiologic Follow-up Study of adults aged 25 and older at baseline are analyzed to track CCU use and survival after hospitalization over 20 years (N=4227). Estimates are derived from Cox proportional-hazards models with time-dependent covariates and from negative binomial and tobit regression analyses. All analyses adjust for disease severity, hospitalization history, and resources. Results. Black adults were less likely than White adults to be admitted to a CCU, even after adjusting for morbidities, health behaviors, previous hospitalization experience, and socioeconomic status. Comparing Black and White adults admitted to CCUs, Black adults spent fewer days and a smaller proportion of their hospital stay in CCUs. Black adults also had fewer CCU stays over the 20-year period and were more likely to die post-discharge, although the latter result was mediated by disease severity. Conclusions. Higher morbidity, lower admission rates, fewer stays, and shorter stays reveal that racial inequality is far-reaching and exists even in such highly-specialized units as CCUs. The fact that Black individuals' greater post-discharge mortality was mediated by disease severity illustrated that even among high-risk individuals, the accumulation of morbidity factors (beyond cardiac problems) is a salient concern. Overall findings demonstrate that the accumulation of disadvantage for Black adults is not confined to discretionary medical measures, but also exists in critical care for serious health problems.

Original languageEnglish (US)
Pages (from-to)145-165
Number of pages21
JournalEthnicity and Health
Volume16
Issue number2
DOIs
StatePublished - Apr 1 2011

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Critical Care
Hospitalization
Morbidity
hospitalization
morbidity
Nutrition Surveys
Health Behavior
Hospital Mortality
Disease
Proportional Hazards Models
Social Class
Length of Stay
mortality
History
Regression Analysis
Intensive Care
Mortality
Health
health behavior
health

Keywords

  • cardiac care
  • health care access
  • prospective cohort study
  • racial disparities

Cite this

Racial disparity in access to cardiac intensive care over 20 years. / Shippee, Tetyana P.; Ferraro, Kenneth F.; Thorpe, Roland J.

In: Ethnicity and Health, Vol. 16, No. 2, 01.04.2011, p. 145-165.

Research output: Contribution to journalArticle

Shippee, Tetyana P. ; Ferraro, Kenneth F. ; Thorpe, Roland J. / Racial disparity in access to cardiac intensive care over 20 years. In: Ethnicity and Health. 2011 ; Vol. 16, No. 2. pp. 145-165.
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