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Disparities in the emergency department evaluation of chest pain patients
Liliana E Pezzin1, Penelope M Keyl, Gary B Green
1Health Policy Institute, Medical College of Wisconsin, Milwaukee, WI, USA. lpezzin@mcw.edu
Insights
Racial and gender disparities exist in emergency department cardiac care. African Americans and women received fewer diagnostic tests for chest pain, highlighting a need for further investigation into healthcare inequities.
Area of Science:
- Cardiology
- Health Services Research
- Health Equity
Background:
- Growing recognition of race and gender disparities in cardiovascular healthcare.
- Limited research on these disparities specifically within the emergency department (ED) setting.
Purpose of the Study:
- To evaluate race, gender, and insurance-based differences in receiving early, noninvasive diagnostic tests for chest pain in the ED.
- To analyze factors influencing the ordering of electrocardiography, cardiac monitoring, pulse oximetry, and chest radiography.
Main Methods:
- Utilized data from the U.S. National Hospital Ambulatory Health Care Survey (1995-2000).
- Included patients aged 30+ presenting to the ED with chest pain.
- Employed multivariate probit analysis to assess test ordering probabilities.
Main Results:
- Non-African American patients had the highest probability of receiving all considered tests.
- African American men showed lower probabilities for electrocardiography and chest radiography compared to non-African American men.
- African American women received cardiac monitoring and oxygen saturation measurements less frequently than non-African American men.
- Uninsured or self-pay patients also had reduced test ordering probabilities.
Conclusions:
- Documented significant race, gender, and insurance disparities in diagnostic testing for chest pain patients in the ED.
- Observed differences in electrocardiography, chest radiography, and monitoring necessitate further research into the root causes of cardiac care inequities.
- Highlights the importance of addressing disparities at the initial point of patient contact within the healthcare system.
Background:
The existence of race and gender differences in the provision of cardiovascular health care has been increasingly recognized. However, few studies have examined whether these differences exist in the emergency department (ED) setting.
Objectives:
To evaluate race, gender, and insurance differences in the receipt of early, noninvasive diagnostic tests among persons presenting to an ED with a complaint of chest pain.
Methods:
Data were drawn from the U.S. National Hospital Ambulatory Health Care Survey of EDs. Visits made during 1995-2000 by persons aged 30 years or older with chest pain as a reason for the visit were included. Factors affecting the likelihood of ordering electrocardiography, cardiac monitoring, oxygen saturation measurement using pulse oximetry, and chest radiography were analyzed using multivariate probit analysis.
Results:
A total of 7,068 persons aged 30 years or older presented to an ED with a primary complaint of chest pain during the six-year period, corresponding to more than 32 million such visits nationally. The adjusted probability of ordering a test was highest for non-African American patients for all tests considered. African American men had the lowest probabilities (74.3% and 62% for electrocardiography and chest radiography, respectively), compared with 81.1% and 70.3%, respectively, among non-African American men. Only 37.5% of African American women received cardiac monitoring, compared with 54.5% of non-African American men. Similarly, African American women were significantly less likely than non-African American men to have their oxygen saturation measured. Patients who were uninsured or self-pay, as well as patients with "other" insurance, also had a lower probability than insured persons of having these tests ordered.
Conclusions:
This study documents race, gender, and insurance differences in the provision of electrocardiography and chest radiography testing as well as cardiac rhythm and oxygen saturation monitoring in patients presenting with chest pain. These observed differences should catalyze further study into the underlying causes of disparities in cardiac care at an earlier point of patient contact with the health care system.
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