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BackgroundInsured adults receive invasive cardiovascular procedures more frequently than uninsured adults. We examined the impact of healthcare reform in Massachusetts on use of coronary revascularization procedures and in-hospital and 1-year mortality by race/ethnicity, education, and sex.Methods and resultsUsing hospital claims data, we compared differences in coronary revascularization rates (coronary artery bypass grafting or percutaneous coronary intervention) and in-hospital mortality by race/ethnicity, education, and sex among Massachusetts residents aged 21 to 64 years hospitalized with a principal discharge diagnosis of ischemic heart disease before (November 1, 2004, to July 31, 2006) and after (December 1, 2006, to September 30, 2008) reform; 1-year mortality was calculated for those undergoing revascularization. Adjusted logistic regression assessed 24 216 discharges before reform and 20 721 discharges after reform. Blacks had 30% lower odds of receiving coronary revascularization than whites in the prereform period. Compared with whites in the postreform period, blacks (odds ratio=0.73; 95% confidence interval, 0.63-0.84) and Hispanics (odds ratio= 0.84; 95% confidence interval, 0.74-0.97) were less likely and Asians (odds ratio=1.29; 95% confidence interval, 1.01-1.65) were more likely to receive coronary revascularization. Patients living in more educated communities, men, and persons with private insurance were more likely to receive coronary revascularization before and after reform. Compared with the prereform period, the adjusted odds of in-hospital mortality were higher in patients living in less-educated communities in the postreform period. No differences in 1-year mortality by race/ethnicity, education, or sex for revascularized patients were observed before or after reform.ConclusionsReducing insurance barriers to receipt of coronary revascularization procedures has not yet eliminated preexisting demographic and educational disparities in acc

Joan Flasch Artists' Book Collection

Joan Flasch Artists' Book Collection

Joan Flasch Artists' Book Collection

Joan Flasch Artists' Book Collection

Edition limited to 12 copies. Cf. Bookdealer's blurb. "Photographs ... taken at the Bawnboy Workhouse, County Cavan, Ireland. Opened in 1852 ... it closed in 1921 and now stands empty"--Colophon. Accordion spine bound between 2 black silk-wrapped boards is held together with 3 sets of black ribbon ties; paste-downs are extensions of the accordion folds; gatherings of plates are sewn to the interior pleats of the accordion folds; text runs continuously across both pages of each interior accordion opening; pagination reflects the book's structure and not the flow of text (i.e. 1 section of text is written on 2 pages of the book); printed with pigmented inkjet print on rag paper. Facsim. of a table of deaths in Ireland in workhouses, etc. is printed on both paste-downs