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Previous Volume 340:618-626 February 25, 1999 Number 8 Next

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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.

Source Information

From the Clinical Economics Research Unit (K.A.S., C.K.T.), the Lombardi Cancer Center (J.F.K.), the Division of General Internal Medicine (S.S.), the Division of Cardiology (B.J.G.), and the Department of Medicine (J.M.E.), Georgetown University Medical Center, Washington, D.C.; the Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology (J.A.B.), and the Division of General Internal Medicine (S.W.), University of Pennsylvania School of Medicine, Philadelphia; Interactive Drama, Bethesda, Md. (W.H., R.D.); and the RAND Health Program, Santa Monica, Calif. (J.E.B., J.J.E.). William Ayers, M.D., Georgetown University Medical Center, Washington, D.C., was also an author.

Address reprint requests to Dr. Schulman at the Clinical Economics Research Unit, Georgetown University Medical Center, 2233 Wisconsin Ave., NW, Suite 440, Washington, DC 20007.

Full Text of this Article

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• Cooper, L. A., Roter, D. L., Johnson, R. L., Ford, D. E., Steinwachs, D. M., Powe, N. R. (2003). Patient-Centered Communication, Ratings of Care, and Concordance of Patient and Physician Race. ANN INTERN MED 139: 907-915 [Abstract] [Full Text]  
• LaVeist, T. A., Arthur, M., Morgan, A., Plantholt, S., Rubinstein, M. (2003). Explaining Racial Differences in Receipt of Coronary Angiography: The Role of Physician Referral and Physician Specialty. Med Care Res Rev 60: 453-467 [Abstract]  
• Tamayo-Sarver, J. H., Hinze, S. W., Cydulka, R. K., Baker, D. W. (2003). Racial and Ethnic Disparities in Emergency Department Analgesic Prescription. AJPH 93: 2067-2073 [Abstract] [Full Text]  
• Evans, J. H. (2003). Commodifying Life? A Pilot Study of Opinions Regarding Financial Incentives for Organ Donation. Journal of Health Politics, Policy and Law 28: 1003-1032 [Abstract]  
• Rucker-Whitaker, C., Feinglass, J., Pearce, W. H. (2003). Explaining Racial Variation in Lower Extremity Amputation: A 5-Year Retrospective Claims Data and Medical Record Review at an Urban Teaching Hospital. Arch Surg 138: 1347-1351 [Abstract] [Full Text]  
• Graham, M. M., Ghali, W. A., Faris, P. D., Galbraith, P. D., Norris, C. M., Knudtson, M. L. (2003). Sex Differences in the Prognostic Importance of Diabetes in Patients With Ischemic Heart Disease Undergoing Coronary Angiography. Diabetes Care 26: 3142-3147 [Abstract] [Full Text]  
• Kamath, C. C., O'Fallon, W. M., Offord, K. P., Yawn, B. P., Bowen, J. M. (2003). Provider Satisfaction in Clinical Encounters With Ethnic Immigrant Patients. Mayo Clin Proc. 78: 1353-1360 [Abstract]  
• Serna, D. S., Lee, S. J., Zhang, M.-j., Baker, K. S., Eapen, M., Horowitz, M. M., Klein, J. P., Rizzo, J. D., Loberiza, F. R. Jr (2003). Trends in Survival Rates After Allogeneic Hematopoietic Stem-Cell Transplantation for Acute and Chronic Leukemia by Ethnicity in the United States and Canada. JCO 21: 3754-3760 [Abstract] [Full Text]  
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