Abstract 3999: The Impact of Race and Insurance Status on Utilization Rates and Outcomes after Coronary Artery Bypass Grafting Surgery in the Commonwealth of Massachusetts
Background: The legislature in Massachusetts (MA) has recently enacted comprehensive reform to enhance access to healthcare. Previous studies have documented racial and insurance-based variations in the application of revascularization procedures for coronary artery disease (CAD). Data on MA are limited. We assessed the association of race and insurance status with utilization rates and outcomes after coronary artery bypass grafting (CABG).
Methods: We used the MA mandatory Adult Cardiac Surgery database linked to the 2000 Bureau of Census data and expected rates of CAD reported by the American Heart Association to analyze outcomes of 12,617 patients undergoing CABG between 2002 and 2004. Three outcomes were modeled:
30-day all-cause mortality
Overall hospital morbidity and
Hospital length of stay.
Multivariable models were constructed by sequentially adding variables to the model in the following order: race, insurance type, patient clinical and operative profiles and socioeconomic status.
Results: CABG was performed more often in white (30.8 procedures / 1000 patients with CAD) compared with African-American (14.9) or Hispanic (17.4) patients. Disparities were also observed across insurance status with patients carrying Government insurance (excluding Medicaid) undergoing 7.4 procedures / 1000 citizens compared with Commercial (1.5), Medicaid (0.4) and uninsured (0.5). Odds Ratios (95% CI) derived from the multivariable analyses are summarized in the Table⇓. (Adjusted for age, sex, ejection fraction and comorbidities, * p<0.001).
Conclusions: Significant racial and insurance-based disparities in CABG surgery utilization exist. However, mortality after CABG was similar regardless of race or type of insurance. Medicaid type of insurance was associated with increased morbidity and length of stay. A comprehensive reform that would enhance access to healthcare may eliminate these disparities and improve outcomes of patients with CAD in MA.