UCSF

Asian Americans constitute one of the fastest growing groups in the United States. This dissertation study explores healthcare disparities in Asian Americans (Asians) through the window of examining those who had coronary artery bypass graft (CABG) surgery in California. The mandatory clinical data registry for CABG surgery, the California CABG Outcomes Reporting Program (CCORP), when linked to California's Patient Discharge Data (PDD), offers a unique opportunity to study Asians. Though the data did not show a significant difference in the overall observed or risk-adjusted operative mortality between Asians and Caucasians, a marginal significant difference was found between Asian females and Asian males (OR, 1.4, p=.057).

More significant differences in preoperative clinical characteristics existed between Asians and Caucasians and within genders in Asians. Twice as many Asians had a very low body mass index (BMI) <18.5 and developed heart disease at a lower mean BMI than Caucasians. Asians suffered more diabetes, hypertension, cerebrovascular disease, renal disease, heart failure, multivessel disease, and mitral insufficiency than Caucasians. Upon further analysis, Asian females were found to contribute to the aforementioned differences more so than Asian males. The finding that significantly fewer Asians had previous CABG surgery or other procedures than Caucasians may indicate problems in disease detection, denial, and referral, as well as access to care.

A significantly higher percentage of Asians compared to Caucasians had CABG surgery performed in the low-volume hospitals, while the converse was true for Caucasians. Significant differences were found for operative mortality between the low-volume and high-volume hospital groups when both racial groups were examined jointly, But these differences became not significant when Asians were examined alone.

Major limitations in this study include lack of information on postoperative complications, ambiguity in the identification of the Asian race, and the absence of other process and outcome data in relation to language and cultural traits. Longitudinal mortality follow-up and quality of life data to assess the cost/benefit ratio of surgery are also lacking. Despite these limitations, this is an important study that employed a large clinical dataset to study CABG surgery with a dedicated focus on Asians. The results provide critical health information that clinicians can use to improve access and clinical outcomes for Asian patients needing CABG surgery.