Although many studies have revealed that blacks have less access to cardiac revascular procedures than do white patients, the reasons for these racial disparities remain unclear. Barriers to receipt of high-quality medical care such as low socioeconomic status are well studied, and lamentably, race and ethnicity are strong correlates of socioeconomic variables in the United States. Bias on the part of medical care providers has also been implicated as a potential mediator of racial and ethnic disparities in access. Unequal geographic distributions of health care professionals, hospitals, and services provided exist in the United States. In New York State, for example, only selected hospitals are licensed to provide advanced cardiac revascularization. Therefore, in many communities, especially in socioeconomic disadvantaged communities, including inner-city neighborhoods, residents who are admitted to their local hospital for coronary heart disease must rely on the availability of transfer to another hospital if they need to receive revascularization. Whether geography-related factors may impede access to care is important question, but one that has not been previously addressed. ? ? The purpose of this study is to determine whether in New York City, there is an association of neighborhood characteristics, independent of race, and cardiac revascularization among coronary heart disease hospitalized patients. The relative importance of individual patient-related characteristics and community characteristics will be assessed. In addition, time-dependent trends of cardiac procedure use over three census period and factors associated with access to procedures will be determined. Finally, an index to define relative access to the cardiac procedures will be developed. Sensitivity analyses will be conducted using multilevel models to estimate the potential improvement of using revascular procedure in disadvantaged neighborhood by changing the associated neighborhood characteristics. This would be important for policy to eliminate the health disparity.
