Disparities in cardiac care: rising to the challenge of Healthy People 2010.

Eliminating health disparities is one of two overarching goals of Healthy People 2010. Although the causes of health disparities are complex, they appear to be related, in part, to disparities in the quality of medical care. Two recent reviews of peer-reviewed research investigated the evidence on racial/ethnic differences in medical care. An Institute of Medicine summary of the literature concluded that in most studies, racial and ethnic disparities in health care remained even after adjustment for potentially confounding factors. A review focused specifically on cardiac care, conducted jointly by the Kaiser Family Foundation and the American College of Cardiology Foundation, reached a similar conclusion after examining the most rigorous studies investigating racial/ethnic differences in angiography, angioplasty, coronary artery bypass graft (CABG) surgery, and thrombolytic therapy. For example, African Americans were statistically less likely than whites to undergo CABG surgery in 21 of the 23 most rigorous studies that calculated odds ratios to compare CABG use. Although there is a convincing body of evidence that race continues to matter in the health system, a nationally representative survey of physicians revealed that the majority of physicians do not view a patient's race/ethnicity as a factor in obtaining care, but do believe insurance coverage matters. Increasing physicians' awareness of the evidence for the role that race/ethnicity plays in health care is important because they are in a good position to directly and indirectly affect changes in clinical practice or patient behavior that could reduce disparities in care.