Study: Black CABG patients disadvantaged in accessing best hospitals

Editor's Note

Black patients are less likely to receive surgery at hospitals with the lowest mortality rates despite living closer to these facilities, according to a new study examining Medicare patients undergoing coronary artery bypass grafting (CABG) from 2017 to 2019. Authors suggest that physician referral patterns may play a role and highlight the need for interventions to optimize these networks to ensure equitable care.

Published December 27 by the American Heart Association (AHA), the study analyzed 76,376 Medicare fee-for-service patients, 5.1% of whom were Black. Researchers focused particularly on the treating physicians and the hospitals where CABG procedures were performed. The strength of connections between physicians and hospitals was assessed by the number of shared CABG patients in the prior two years. Statistical models accounted for variables such as race, hospital quality, and home-to-hospital distance to evaluate hospital selection patterns.

Although Black and White patients were treated at hospitals with similar average mortality rates (3.1% for both groups, P=0.07), Black patients resided closer to lower-mortality hospitals compared to their White counterparts (2.5% vs. 2.7% mean hospital mortality within median travel distance, P<0.001). However, Black patients were less frequently treated at the lowest-mortality hospitals both overall (10.5% vs. 13.9%) and within the median travel distance (37.4% vs. 45.1%, P<0.001 for both comparisons).

The statistical models indicated that Black patients’ likelihood of being treated at higher-mortality hospitals persisted after accounting for home-to-hospital distances (adjusted risk ratio 1.07, P<0.001). However, when physician-hospital ties were included in the analysis, the risk ratio was no longer statistically significant (1.06, P=0.11).

The study concludes that although prior disparities in hospital quality for CABG patients have improved, Black patients remain disadvantaged in accessing the best-quality hospitals. 

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