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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

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