Equal-access insurance eliminates racial disparities in CABG patients
A study out of Brigham and Women’s Hospital in Boston has found patients insured through TRICARE, the U.S. military’s universal health insurance program, saw similar coronary artery bypass grafting (CABG) outcomes regardless of their race.
Like many, the study’s authors, led by Muhammad Ali Chaudhary, MD, a research fellow at the Brigham, were aware of repeated racial and sex disparities in CABG outcomes across the country. One paper published last summer found that while CABG utilization had dropped between 1999 and 2014 and in-hospital mortality rates declined, women and black patients saw the fewest improvements. And of the 1.8 million Medicare beneficiaries included in that study, just 37% of CABG candidates were women and 5% were black.
Chaudhary and colleagues looked to TRICARE as a model of universal healthcare—a topic that’s drummed up a fair amount of attention in the ongoing presidential debates. As a universal insurance and equal-access system that covers more than 9 million active-duty members, veterans and their families, Chaudharhy et al. said TRICARE comprises a more socially, geographically and ethnically diverse patient population than a system like Medicare, which is restricted to a specific age range.
The researchers studied 8,183 TRICARE patients, aged 18-64, who underwent CABG between 2006 and 2014. The team’s primary outcomes were three quality-of-care metrics endorsed by the National Quality Forum for CABG: prescription of beta-blockers, prescription of statins and 30-day readmission rates.
Focusing squarely on racial disparities, Chaudhary and colleagues reported few differences in patient outcomes. Black patients saw 10% higher odds of beta-blocker prescription and 10% lower odds of 30-day readmission than whites, but neither of those findings were statistically significant.
“In our study, we found a complete absence of racial disparities,” Chaudhary said in a release from the Brigham. “In the military, the color of your uniform matters more than the color of your skin. Here, we have an opportunity to look beyond just the impact of universal insurance. This is a system that may be eliminating other factors that contribute to racial disparities in care such as implicit provider bias, healthcare segregation, differential access to care and mistrust in the system.”
Because their data were drawn from the TRICARE database, Chaudhary said his team couldn’t account for physicians’ reasons for prescribing—or not prescribing—medication to individual patients. Still, he said TRICARE’s reach allows them to view this analysis as a more realistic glimpse into what universal healthcare could look like for heart surgery patients.
“It’s one of the hypotheses that we’ve been building for years: universal healthcare access and equal access can eradicate racial disparities,” he said. “With TRICARE, we have a model that provides a window into the potential impacts of universal insurance and an equal-access healthcare system.”
Chaudhary and co-authors published their results this month in Health Affairs.
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.