Coronary revascularization in older women and men in the United States: trends in ethnic differences

Abstract

Background Many reports of ethnic differences in utilization of coronary artery bypass grafting (CABG) have been published in the past 2 decades. However, revascularization trends in elderly ethnic minorities have received little attention. Objectives The purpose of the present study was to determine whether ethnic differences in rates of CABG and percutaneous transluminal coronary angioplasty (PTCA) decreased after 1990 among elderly women and men. Methods Data from the Centers for Medicare and Medicaid Services were examined for the years 1990 through 1997–99. Numbers of CABG and PTCA procedures performed in Medicare enrollees were used to compute rates per 100,000 non-HMO beneficiaries by year, sex, and ethnicity for persons aged ≥65 years. Results In women and men, the rate of CABG increased in African Americans and in European Americans between 1990 and 1996. However, a decline in numbers and rates of CABG was noted for the first time in 1997. Between 1990 and 1997, the ratio of rates in European Americans to those in African Americans declined somewhat (eg, in women, from 1.79 in 1990 to 1.55 in 1997). Along with steady rapid increases in rates of PTCA in both groups, a decrease in this ratio was noted (eg, in women, from 2.09 in 1990 to 1.54 in 1997 to 1.44 in 1999). This ratio was higher at ages 75 to 84 years than at 65 to 74, declining most at 75 to 84. Conclusions Despite apparent decreases in ratios of rates in European Americans to those in African Americans for CABG and inpatient PTCA from 1990–1999, large ethnic differences in utilization of CABG and PTCA persist in the elderly, requiring further evaluation and possible intervention.