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Use of Smoking Cessation Interventions and Aspirin for Secondary Prevention: Are There Racial Disparities?

Houston Center for Quality of Care and Uti-lization Studies, a Health Services Research and Development Center of Excellence, Michael E. Debakey VA Medical Center, and Section for Health Services Research and with Section on Hypertension-Clinical Pharmacology, Department of Medicine, Baylor College of Medicine, Houston, Tex

LeChauncy D. Woodard, MD, MPH

Houston Center for Quality of Care and Utilization Studies, a Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center, and Section for Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Tex

Nancy R. Kressin, PhD

Department of Veterans Af-fairs, Center for Health Quality, Outcomes and Economic Research, a Health Services Research and Development Center of Excellence, Bedford VA Medical Center, Bedford, Mass, and the Health Services Department, Boston University School of Public Health, Bedford, Mass

Laura A. Petersen, MD, MPH

Houston Center for Quality of Care and Utilization Studies, a Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center, and Section for Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Tex, laurap{at}bcm.tmc.edu

We examined whether racial differences exist in the use of aspirin and smoking cessation interventions for secondary prevention in veterans with coronary artery disease (CAD). We enrolled a total of 1045 African-American and white patients with CAD at 5 Veterans Administration hospitals between 1999 and 2001. Data were obtained by chart review. Among current smokers, African-American and white patients were equally likely to receive smoking cessation interventions (55.8% versus 56.1%; P = .97). Similarly, among ideal candidates for aspirin therapy, there was no difference in overall treatment rates between the 2 groups (74.1% versus 73.4%; P = .85). However, in the subsets of ideal candidates with hypercholesterolemia and previous stroke, African-Americans were less likely than whites to receive aspirin (P < .05). In contrast, African-Americans with hypertension were more likely than whites to receive aspirin (P = .05). Our findings highlight the need for improvement in use of smoking cessation interventions and aspirin among all patients with CAD and indicate an area where future quality improvement efforts may be warranted.

Key Words: Aspirin • coronary artery disease • racial differences • secondary prevention • smoking

American Journal of Medical Quality, Vol. 19, No. 4, 166-171 (2004)
DOI: 10.1177/106286060401900405


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