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Differences between blacks and whites with coronary heart disease in initial symptoms and in delay in seeking care
S B Richards1, M Funk, K A Milner
1Yale University School of Nursing, New Haven, Conn, USA.
Insights
Blacks with coronary heart disease (CHD) are more likely to experience shortness of breath and left-sided chest pain. While treatment delays were not significantly different, Black patients tended to wait longer for care.
Area of Science:
- Cardiology
- Public Health
- Health Disparities
Background:
- Coronary heart disease (CHD) mortality rates are higher in Black populations compared to White populations.
- Understanding racial differences in CHD symptom presentation and treatment-seeking behavior is crucial for improving outcomes.
Purpose of the Study:
- To investigate disparities in coronary heart disease symptom manifestation between Black and White patients.
- To analyze differences in the time taken to seek medical treatment for suspected coronary heart disease between racial groups.
Main Methods:
- Direct observation of patients presenting to an emergency department with symptoms indicative of coronary heart disease.
- Analysis of a sample comprising 40 Black and 191 White patients diagnosed with angina or acute myocardial infarction.
Main Results:
- Black patients were significantly more likely to report shortness of breath (OR=3.16) and left-sided chest pain (OR=2.55) as presenting symptoms, even after adjusting for demographic and clinical factors.
- Mean delay in seeking care was comparable between racial groups (Blacks: 26.8 hours; Whites: 24.4 hours).
- Median delay in seeking care showed borderline significance (P=.05), with Black patients experiencing longer delays (11 hours) than White patients (5 hours).
Conclusions:
- Shortness of breath and left-sided chest pain are more prevalent presenting symptoms of coronary heart disease in Black individuals compared to White individuals.
- While not statistically significant, a trend suggests longer treatment delays for Black patients.
- The study's findings on racial differences in symptoms and treatment delays may be influenced by the smaller sample size of Black participants.
Background:
Mortality rates for coronary heart disease are higher in blacks than in whites.
Objectives:
To examine differences between blacks and whites in the manifestation of symptoms of coronary heart disease and in delay in seeking treatment.
Methods:
Patients were directly observed as they came to an emergency department with symptoms suggestive of coronary heart disease. The sample included 40 blacks and 191 whites with a final diagnosis of angina or acute myocardial infarction.
Results:
After controlling for pertinent demographic and clinical characteristics, logistic regression analysis revealed that blacks were more likely than whites to have shortness of breath (odds ratio = 3.16; 95% CI = 1.49-6.71; P = .003) and left-sided chest pain (odds ratio = 2.55; 95% CI = 1.10-5.91; P =.03). Blacks delayed a mean of 26.8 hours (SD = 30.3; median = 11 hours), whereas whites delayed a mean of 24.4 hours (SD = 41.7; median = 5 hours) in seeking care. Mean delay time was not significantly different for blacks and whites; differences in median delay time were of borderline significance (P = .05).
Conclusions:
Blacks were more likely than whites to have shortness of breath and left-sided chest pain as the presenting symptoms of coronary heart disease. Differences in delay in seeking treatment were not significant, although blacks tended to delay longer than did whites. The relatively small number of blacks may account for the lack of observed racial differences in both initial symptoms and in delay in seeking treatment.