Black patients on dialysis are less likely than their white counterparts to under percutaneous coronary intervention (PCI), according to a new study.
The racial disparity emerged in a study of Medicare inpatient claims for PCI in a cohort of 268,575 patients with Medicare as the primary payer and who initiated maintenance dialysis from January 1, 2009 through June 1, 2013. A team led by Robert Nee, MD, of Walter Reed National Military Medical Center in Bethesda, Maryland, found that blacks had a significant 36% decreased likelihood of undergoing PCI compared with whites after adjusting for demographic, clinical, and socioeconomic factors.
“A racial gap exists in the receipt of percutaneous coronary intervention among dialysis patients despite having comprehensive coverage with Medicare insurance, highlighting the crucial need for effective implementation of local and national strategies to promote racial equity in cardiovascular health,” Dr Nee and his colleagues wrote in the Journal of the American Heart Association.
The study population included 73,209 black patients (27.3%), 182,772 white patients (68%), and 12,594 patients of other races (4.7%). Black patients were significantly younger at dialysis initiation than white patients (mean 60 vs 66 years). A significantly higher proportion of black patients compared with white patients were unemployed (28.3% vs 16.9%) and had dual eligibility for Medicare and Medicaid. Of the entire cohort, 17,261 patients (6.4%) had at least 1 PCI procedure. The crude incidence rate was 22.3 procedures per 1000 patient-years. The overall prevalence of PCI was 6.9% among whites compared with 5.0% among blacks. The unadjusted incidence rates for blacks and whites were 25.8 and 15.5 per 1000 person-years. White male patients had the highest incidence rate compared with other groups by race and sex (26.7 per 1000 person-years) and black male patients had the lowest rate (14.1 per 1000 person-years).
Compared with white males, white females, black females, and black males had a significant 13%, 37%, and 42% decreased likelihood of undergoing PCI, respectively.
Nee R, Yan G, Yuan CM, et al. Use of percutaneous coronary intervention among black and white patients with end-stage renal disease in the United States. J Am Heart Assoc. 2019;8:e012101. doi: 10.1161/JAHA.119.012101