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Department of Economics

Project Abstract

"Does Controlling for Patient Preferences Eliminate the Racial Variation in the Treatment of Coronary Artery Disease?"

Ryan Mutter

The health services research literature has consistently demonstrated that African Americans receive inferior care for heart disease. Studies that have documented this phenomenon have failed to attribute it to either clinical factors or differences in insurance status. Recent studies have suggested that the racial variation in the treatment of heart disease might be due to either patient preferences or physician decision-making. These theories, however, have not been tested with logistic regression, the standard procedure used to demonstrate the differences in the treatment of African Americans and whites.

This study controls for patient preferences by only examining patients who were willing to undergo surgical treatments for their heart disease. For its benchmark estimates, this study limits itself to diabetic heart patients, a class of individuals whose heart disease should be treated with coronary artery bypass grafting (CABG) instead of angioplasty. For this subset of patients, logistic regression finds that blacks are less likely than whites to receive CABG (odds ratio, 0.762; 95 percent confidence interval, 0.632 to 0.919; P=0.004). The fact that the racial variation in the surgicanl treatment of heart disease persists after controlling for patient preferences suggests that physician decision-making is a factor in explaining the differences in the way African Americans and whites with heart disease are treated.

DEPARTMENT OF ECONOMICS • University of Maryland, Baltimore County
3rd floor Public Policy Building, Room 338
1000 Hilltop Circle • Baltimore Maryland 21250
phone: 410-455-2160 • email: Mrs. Kelly Hodges <khodges@umbc.edu>