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October 26, 1994

Racial Differences in Cardiac Procedure Use-Reply

Author Affiliations

Duke University Medical Center Durham, NC
West Roxbury Veterans Affairs Medical Center West Roxbury, Mass

JAMA. 1994;272(16):1251-1252. doi:10.1001/jama.1994.03520160035024

In Reply.  —Dr Zucker raises the concern that our findings of racial variation in cardiac procedure use in the Veterans Health Administration (VHA) may be explained by unmeasured differences in severity of illness or comorbidity. In the "Comment" section of our article and in subsequent interviews, we acknowledged this limitation of administrative data and, therefore, did not conclude that our findings proved VHA care was "racially biased."1,2 Instead, we suggested that using detailed clinical databases for further investigating the remaining cause for these variations in care and outcome was indicated. As an example, a subsequent preliminary report suggests that black veterans with angiographically defined coronary disease remained significantly less likely than whites to receive revascularization procedures after adjusting for history, cardiac risk factors (including smoking), and lesion severity.3We would also agree with Zucker that SES is an important determinant of health outcomes. Although we were not able

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