CLINICAL STUDY
The cardiac access longitudinal study
A study of access to invasive cardiology among African American and white patients
Thomas A. LaVeist, PhD*,*,
Melanie Arthur, PhD ,
Athol Morgan, MD, MHS ,
Michael Rubinstein, MD||,
Joanne Kinder, RN ,
Linda M. Kinney, MPA* and
Stephen Plantholt, MD
* Center for Health Disparities Solutions, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
Oregon Health & Sciences University, Portland, Oregon, USA
One Heart, Limited Liability Company, Baltimore, MarylandUSA
Department of Cardiology, St. Agnes Healthcare, Portland, OregonUSA
|| Department of Cardiology, Bon Secours Baltimore Health System, Baltimore, Maryland, USA
Manuscript received November 5, 2001;
revised manuscript received September 20, 2002,
accepted October 25, 2002.
* Reprint requests and correspondence: Dr. Thomas A. LaVeist, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, Maryland 21205, USA.
tlaveist{at}jhsph.edu
OBJECTIVES: We sought to identify factors contributing to racial disparity in the receipt of coronary angiography (CA).
BACKGROUND: Numerous studies have demonstrated that African American patients are less likely to receive needed diagnostic and therapeutic coronary procedures than white patients. This report summarizes the methods and findings of a study linking medical records with patient and physician interviews to address racial disparities in the utilization of CA.
METHODS: This is a retrospective, cross-sectional study conducted in three urban hospitals in Maryland. A total of 9,275 medical records were reviewed, representing all 7,058 cardiac patients admitted in a two-year period. We identified 2,623 patients who, according to American College of Cardiology guidelines, were candidates for receiving CA. A total of 1,669 patients (721 African Americans and 948 whites) and 74% of their physicians were successfully interviewed. Multivariate and hierarchical multivariate logistic regression were used to construct a model of receipt of CA within one year of the hospitalization.
RESULTS: The unadjusted odds of white patients receiving CA was three times greater than the odds for African American patients (odds ratio [OR] 3.0, 95% confidence interval [CI] 2.4 to 3.7). Adjusting for patients’ clinical and social characteristics resulted in a 13% reduction in the OR for race. Adjusting for physician and health care system characteristics reduced the OR by 43%, to 1.7 (95% CI 1.3 to 2.4).
CONCLUSIONS: Racial disparity in the utilization of CA is a function of differences in the health care system "context" in which African American and white patients obtain care, combined with differences in the specific clinical characteristics of patients.
|
Abbreviations and Acronyms
| | ACC | = American College of Cardiology | | ADL | = activities of daily living | | AHA | = American Heart Association | | AMI | = acute myocardial infarction | | CA | = coronary angiography | | CI | = confidence interval | | DRG | = diagnostic related group | | OR | = odds ratio | | RR | = risk ratio |
|
This article has been cited by other articles:
|
|
|
|
 
J. A. Spertus, P. G. Jones, F. A. Masoudi, J. S. Rumsfeld, and H. M. Krumholz
Factors Associated With Racial Differences in Myocardial Infarction Outcomes
Ann Intern Med,
March 3, 2009;
150(5):
314 - 324.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. A. Siminoff, L. R. M. Hausmann, and S. Ibrahim
Barriers to Obtaining Diagnostic Testing for Coronary Artery Disease Among Veterans
Am J Public Health,
December 1, 2008;
98(12):
2207 - 2213.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Nasir, L. J. Shaw, S. T. Liu, S. R. Weinstein, T. R. Mosler, P. R. Flores, F. R. Flores, P. Raggi, D. S. Berman, R. S. Blumenthal, et al.
Ethnic Differences in the Prognostic Value of Coronary Artery Calcification for All-Cause Mortality
J. Am. Coll. Cardiol.,
September 4, 2007;
50(10):
953 - 960.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. van Ryn, D. Burgess, J. Malat, and J. Griffin
Physicians' Perceptions of Patients' Social and Behavioral Characteristics and Race Disparities in Treatment Recommendations for Men With Coronary Artery Disease
Am J Public Health,
February 1, 2006;
96(2):
351 - 357.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. G. Mainous III, D. E. King, D. R. Garr, and W. S. Pearson
Race, Rural Residence, and Control of Diabetes and Hypertension
Ann. Fam. Med,
November 1, 2004;
2(6):
563 - 568.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Voigt, R. Ezzeddine, W. Barrington, O. Obiaha-Ngwu, L. I. Ganz, B. London, and S. Saba
Utilization of implantable cardioverter-defibrillators in survivors of cardiac arrest in the United States from 1996 to 2001
J. Am. Coll. Cardiol.,
August 18, 2004;
44(4):
855 - 858.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
