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Some care disparities among blacks may be due to low technology use in hospitals that treat mostly black patients

Hospitals with more black patients are less likely to perform procedures involving new technologies such as dual-chambered pacemaker implantation and lumbar spinal fusion, according to a recent study supported in part by the Agency for Healthcare Research and Quality (T32 HS00028). Thus, a slower rate of technology diffusion at these hospitals may be a remediable cause of health care disparities among blacks, concludes Peter W. Groeneveld, M.D., M.S., of the University of Pennsylvania School of Medicine.

Dr. Groeneveld and his colleagues used Medicare data from 1989-2000 to examine use of one of five emerging medical technologies during the 12-year period among 2,348,952 hospitalized Medicare patients aged 65 or older. The five technologies were aortic valve replacement with a tissue valve (bioprosthesis), internal mammary artery coronary bypass grafting (IMA-CABG), dual-chamber pacemaker implantation, vena cava interruption, and lumbar/lumbosacral spinal fusion.

Compared with whites admitted to hospitals with a patient population comprising less than 9 percent black patients, whites and blacks admitted to hospitals with patient populations that included more than 20 percent blacks had lower rates, respectively, of bioprosthetic aortic valve replacement (odds ratio 0.66 and 0.70), IMA-CABG (OR 0.89, 0.78), dual-chamber pacemaker implantation (OR 0.88, 0.70), and spinal fusion (OR 0.86, 0.88); on the other hand, they were more likely to receive vena cava interruption (OR 1.17, 1.23).

After adjustment for other factors such as age, sex, income level, and admission year, blacks at these hospitals had 17 percent to 57 percent lower procedure rates than whites for four of the five procedures. Blacks underwent 36 percent more vena cava interruption procedures (OR 1.36) than whites. This procedure is often the consequence of failed oral anticoagulation therapy and may be a marker for lower quality of care for thromboembolic disease, according to Dr. Groeneveld.

More details are in "Technology diffusion, hospital variation, and racial disparities among elderly Medicare beneficiaries 1989-2000," by Dr. Groeneveld, Sara B. Laufer, M.A., and Alan M. Garber, M.D., Ph.D., in the April 2005 Medical Care 43(4), pp. 320-329.

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