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Older black and white people develop heart disease at similar rates, but white Medicare patients are almost four times more likely to have heart bypass operations than black ones, a study said Wednesday.

Black poverty, reluctance to undergo surgery or racial prejudice on the part of doctors may be to blame, said researchers who analyzed records of 86,463 Medicare bypass patients in 1986.The study, published in Wednesday's Journal of the American Medical Association, was the largest of its type.

"We need to know exactly where the breakdown in the system is," said co-author Dr. Arthur J. Hartz of the Medical College of Wisconsin. "For example, is it that blacks do not seek care, prefer not to have high technology care or don't trust their physicians?"

The study found similar rates of hospitalization for heart attacks among both races, suggesting that whites and blacks over 65 develop heart disease at similar rates.

"We believe health care-seeking behavior and physician decision-making are the main factors. We're not able to determine the relative importance of those two," Hartz said.

Dr. Lawrence Cohn, chief of cardiac surgery at Brigham and Women's Hospital in Boston, said, however, that heart disease may show up differently in blacks and whites.

An example is a heart condition called hypertensive cardiomyopathy cannot be corrected with bypass surgery. It results from high blood pressure, which is much more common among blacks than whites.