Minority Health/Disparities Research

Racial disparities in use of coronary angiography are due in part to variation in physician referral patterns

Studies show that white patients are twice as likely as black patients to receive coronary angiography (CA), an imaging procedure to diagnose heart problems, and revascularization procedures to correct these problems (coronary bypass surgery or coronary angioplasty). Fewer angiographies among black heart disease patients may be due in part to less access of black patients to cardiologists, who are more likely to recommend coronary angiography, suggests a new study.

In the study, which was supported in part by the Agency for Healthcare Research and Quality (HS11435), racial disparity in receipt of angiography was reduced among black and white patients who saw cardiologists. Racial differences in access to specialty care, such as cardiology consultations, and variation in referral patterns by physician specialty must be eliminated in order to improve cardiac quality of care, suggests Thomas A. LaVeist, Ph.D. Dr. LaVeist is Professor of Health Services Research and Director of the Hopkins Center for Health Disparities Solutions at the Johns Hopkins Bloomberg School of Public Health.

Dr. LaVeist and his colleagues used data from the Cardiac Access Longitudinal Study, an ongoing study of medical care access, use, and quality of life among white and black cardiac patients from three Baltimore hospitals. They examined the medical records of patients discharged from the hospitals in 1995 and 1997 with a cardiac-related diagnosis to determine if the patient was an appropriate candidate to receive CA. Appropriate candidates for CA (2,623 patients) were interviewed to determine if they had a cardiac consultation during hospitalization, were referred for CA, and if they had CA. Patient reports were confirmed by medical records.

Cardiology consultation was associated with a substantially increased likelihood of referral for CA. White patients had 2.2 times greater odds than black patients of being seen by a cardiologist during their hospitalization. Compared with white patients, black patients had 2.4 times greater odds than white patients of not obtaining a referral for CA, and 1.89 times greater odds of not receiving the procedure. However, this difference in receipt of CA was reduced to 1.4 among patients who received a referral for CA.

See "Explaining racial differences in receipt of coronary angiography: The role of physician referral and physician specialty," by Dr. LaVeist, Melanie Arthur, Ph.D., Athol Morgan, M.D., M.H.S., and others, in the December 2003 Medical Care Research and Review 60(4), pp. 453-467.

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