Published Online
on June 30, 2003

A more recent version of this article appeared on July 22, 2003

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Submitted on March 4, 2003
Revised on April 17, 2003
Accepted on April 18, 2003

Racial Disparity in Cardiac Procedures and Mortality Among Long-Term Survivors of Cardiac Arrest

Peter W. Groeneveld MD, MS^*, Paul A. Heidenreich MD, MS, and Alan M. Garber MD, PhD

From the Center for Primary Care and Outcomes Research (P.W.G., A.M.G.), Stanford University, Stanford, Calif; Veterans Affairs Palo Alto Health Care System (P.A.H., A.M.G.), Palo Alto, Calif; and National Bureau of Economic Research (A.M.G.), Stanford, Calif.

^* To whom correspondence should be addressed. E-mail: petegro{at}healthpolicy.stanford.edu.

Background--It is unknown whether white and black Medicare beneficiaries have different rates of cardiac procedure utilization or long-term survival after cardiac arrest.

Methods and Results--A total of 5948 elderly Medicare beneficiaries (5429 white and 519 black) were identified who survived to hospital discharge between 1990 and 1999 after admission for cardiac arrest. Demographic, socioeconomic, and clinical information about these patients was obtained from Medicare administrative files, the US census, and the American Hospital Association's annual institutional survey. A Cox proportional hazard model that included demographic and clinical predictors indicated a hazard ratio for mortality of 1.30 (95% CI 1.09 to 1.55) for blacks aged 66 to 74 years compared with whites of the same age. The addition of cardiac procedures to this model lowered the hazard ratio for blacks to 1.23 (95% CI 1.03 to 1.46). In analyses stratified by race, implantable cardioverter-defibrillators (ICDs) had a mortality hazard ratio of 0.53 (95% CI 0.45 to 0.62) for white patients and 0.50 (95% CI 0.27 to 0.91) for black patients. Logistic regression models that compared procedure rates between races indicated odds ratios for blacks aged 66 to 74 years of 0.58 (95% CI 0.36 to 0.94) to receive an ICD and 0.50 (95% CI 0.34 to 0.75) to receive either revascularization or an ICD.

Conclusions--There is racial disparity in long-term mortality among elderly cardiac arrest survivors. Both black and white patients benefited from ICD implantation, but blacks were less likely to undergo this potentially life-saving procedure. Lower rates of cardiac procedures may explain in part the lower survival rates among black patients.

Key words: heart arrest • prognosis • survival • aging

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