Minority Health Archive

The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catheterization

Schulman, Kevin A. and Berlin, Jesse A. and Harless, William and Kerner, Jon F. and Sistrunk, Shyrl and Gersh, Bernard J. and Dubé, Ross and Taleghani, Christopher K. and Burke, Jennifer E. and Williams, Sankey and Eisenberg, John M. and Escarce, José J. and Ayers, William (1999) The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catheterization. New England Journal of Medicine, 340 (8). pp. 618-626.

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Abstract

Background Epidemiologic studies have reported differences in the use of cardiovascular procedures according to the race and sex of the patient. Whether the differences stem from differences in the recommendations of physicians remains uncertain. Methods We developed a computerized survey instrument to assess physicians' recommendations for managing chest pain. Actors portrayed patients with particular characteristics in scripted interviews about their symptoms. A total of 720 physicians at two national meetings of organizations of primary care physicians participated in the survey. Each physician viewed a recorded interview and was given other data about a hypothetical patient. He or she then made recommendations about that patient's care. We used multivariate logistic-regression analysis to assess the effects of the race and sex of the patients on treatment recommendations, while controlling for the physicians' assessment of the probability of coronary artery disease as well as for the age of the patient, the level of coronary risk, the type of chest pain, and the results of an exercise stress test. Results The physicians' mean (±SD) estimates of the probability of coronary artery disease were lower for women (probability, 64.1±19.3 percent, vs. 69.2±18.2 percent for men; P<0.001), younger patients (63.8±19.5 percent for patients who were 55 years old, vs. 69.5±17.9 percent for patients who were 70 years old; P<0.001), and patients with nonanginal pain (58.3±19.0 percent, vs. 64.4±18.3 percent for patients with possible angina and 77.1±14.0 percent for those with definite angina; P<0.001). Logistic-regression analysis indicated that women (odds ratio, 0.60; 95 percent confidence interval, 0.4 to 0.9; P=0.02) and blacks (odds ratio, 0.60; 95 percent confidence interval, 0.4 to 0.9; P=0.02) were less likely to be referred for cardiac catheterization than men and whites, respectively. Analysis of race–sex interactions showed that black women were significantly less likely to be referred for catheterization than white men (odds ratio, 0.4; 95 percent confidence interval, 0.2 to 0.7; P=0.004). Conclusions Our findings suggest that the race and sex of a patient independently influence how physicians manage chest pain.


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Item Type: Article
Additional Information: This article is available at the publisher’s Web site. Access to the full text is subject to the publisher’s access restrictions.
Uncontrolled Keywords: cardiovascular procedures; race and sex; cardiac catheterization; chest pain
Subjects: Health
Health > Public Health > Chronic Illness & Diseases > Cardiovascular Disease
Research
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Depositing User: Users 141 not found.
Date Deposited: 05 Dec 2008
Last Modified: 15 Jul 2011 09:28
Link to this item (URI): http://health-equity.pitt.edu/id/eprint/1158

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