Racial Disparities in Health Outcomes Following CABG

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DESCRIPTION (provided by applicant): More than 12 million people in the U.S. have coronary heart disease (CHD), the 2nd leading cause of hospitalization. The CHD death rate is higher for African Americans than for any other racial or ethnic group for which data are recorded. Although coronary artery bypass grafting (CABG) is one of the most common invasive interventions used to treat CHD, African-Americans are less likely to undergo CABG than Caucasians with equivalent severity of disease, and experience higher post-surgical morbidity and mortality. We do not yet have a full understanding of the complex factors that cause these disparities. Some attribute the cause to physiologic or genetic underpinnings, while others contend that race is a social construct with powerful financial consequences impacting health status and health access. Most prior research examining racial disparities in post-CABG outcomes has utilized retrospective analyses, has not controlled well for confounding factors, has limited outcome assessment to morbidity and mortality, and has not accounted for the impact of health-care access upon outcomes. The purpose of the proposed research is to describe differences in CHD-modifiable risk factors, health care access and utilization, and post-surgical outcomes over time in matched African-Americans and Caucasians undergoing isolated CABG, using a prospective between-subjects repeated measures comparative survey design. Subjects will be matched by age, gender, number and source of conduit vessels, and income. Data on modifiable risk factors, health care access and utilization, and outcomes (complications, health-related quality of life and functional status) will be measured at baseline, 3 and 6 months, and compared to determine relationships and effects. My long-term career goal is to develop an independent program of research to reduce health and healthcare disparities in African-Americans undergoing invasive cardiac procedures. To meet this goal, I have developed an intensive training plan to improve my ability to: 1) design and conduct prospective research to understand and reduce disparities in patients with CHD, 2) improve my understanding of issues impacting racial minority health and health-care disparities, and expertise in conducting minority-focused studies, 3) manage and analyze longitudinal data (emphasizing prediction modeling), and 4) prepare and administer grants by participating in multidisciplinary and inter-institutional activities with expert researchers.