Related Experiment Videos
Physician referral patterns and race differences in receipt of coronary angiography
Thomas A LaVeist1, Athol Morgan, Melanie Arthur
1Johns Hopkins University, Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD 21205, USA.
Insights
Race significantly impacts referral for coronary angiography (CA) despite eligibility. However, once referred, African American and white patients show no difference in receiving CA, indicating disparities occur earlier in the treatment decision process.
Area of Science:
- Cardiology
- Health Disparities Research
- Health Services Research
Background:
- Racial disparities in healthcare access and utilization are a significant concern.
- Understanding referral patterns for invasive cardiac procedures like coronary angiography (CA) is crucial for addressing these disparities.
Purpose of the Study:
- To investigate if race predicts referral for coronary angiography (CA) among eligible patients.
- To determine if racial disparities exist in receiving CA after a referral is obtained.
Main Methods:
- Retrospective analysis of 7,927 hospital records from three Baltimore community hospitals.
- Identification of 2,653 eligible candidates for CA, followed by telephone contact to ascertain referral status.
- Logistic regression used to analyze racial differences in referral, controlling for confounders, and to examine differences in procedure receipt among referred patients.
Main Results:
- Race was a significant predictor of referral for CA, even after adjusting for factors like hospital facility, clinical guidelines (ACC/AHA classification), sex, age, and insurance status (OR = 3.0, p < .05).
- No significant racial disparities were observed in the utilization of CA among patients who had already received a referral for the procedure.
Conclusions:
- Racial disparities in coronary angiography (CA) utilization primarily emerge during the treatment decision-making phase, specifically in the referral process.
- Once referred, African American patients are as likely as white patients to undergo CA, suggesting that interventions should focus on improving equitable referral practices.
Objective:
This study addresses the following research questions: (1) Is race a predictor of obtaining a referral for coronary angiography (CA) among patients who are appropriate candidates for the procedure? (2) Is there a race disparity in obtaining CA among patients who obtain a referral for the procedure?
Study Setting:
Three community hospitals in Baltimore, Maryland.
Study Design:
We abstracted hospital records of 7,927 patients from three hospitals to identify 2,653 patients who were candidates for CA. Patients were contacted by telephone to determine if they received a referral for CA. Logistic regression was used to assess whether racial differences in obtaining a referral were affected by adjustment for several potential confounders. A second set of analyses examined race differences in use of the procedure among a subsample of patients that obtained a referral.
Principal Findings:
After controlling for having been hospitalized at a hospital with in-house catheterization facilities, ACC/AHA (American College of Cardiology/American Heart Association) classification, sex, age, and health insurance status, race remained a significant determinant of referral (OR = 3.0, p < .05). Additionally, we found no significant race differences in receipt of the procedure among patients who obtained a referral.
Conclusions:
Our results demonstrate that race differences in utilization of CA tend to occur during the process of determining the course of treatment. Once a referral is obtained, African American patients are not less likely than white patients to follow through with the procedure. Thus, future research should seek to better understand the process by which the decision is made to refer or not refer patients.