Date and Time
February 26, 2003
1:30 PM - 3:00 PM

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Open to the public
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Introduction: It has been well documented that there are racial disparities in the use of many major medical procedures. However, it is unknown if rates of disparity have changed over time. Newer medical technologies may be utilized inequitably early in development with decreasing disparity in utilization as the technology diffuses and the volume increases. Methods: We examined discharge abstracts from a 20% random sample of elderly Medicare beneficiaries from 1989-1999 to measure overall procedure utilization among these patients. We used a modified version of the Agency for Healthcare Research and Quality's Clinical Classification System to identify 9 procedures that had expanded in use by at least 5% annually over this time period, and which had achieved substantial volume nationwide by the year 2000. We subsequently identified 11 comparable procedures which has modest (0-2.5%) annual growth in volume. After identifying diagnostic codes related to use of each procedure, we established 20 cohorts of patients (total n=9,851,866) who were potential candidates over the years 1989-2000. We performed multivariate logistic regression to determine if there were racial differences in procedure use within 90 days of hospital admission, and if such racial differences had changed over the 12-year study period. Results: We noted significantly lower procedure utilization rates in the year 2000 among black patients for 5 of 9 emerging technologies, as well as for 3 of 11 established medical procedures. Among emerging technologies, only internal mammary artery coronary artery bypass grafting and cardiac electrophysiology studies showed significant trends of declining racial differences in utilization. Among established technologies, both spinal laminectomy and toe amputation occurred in more equivalent proportions of whites and blacks over time. Conclusions: Among elderly Medicare beneficiaries, lower technology utilization for blacks remains common for several medical procedures. However, substantial changes over time in the racial proportion of procedure use are uncommon. Reductions in racial differences in procedure utilization over time do not generally appear to be related to the growth rate of the technology.