Boston University News Release

29th November, 2004

Understanding Racial Disparities in Cardiac Care

(Boston) – Patients’ beliefs play little or no role in explaining racial disparities in cardiac care, according to a new Boston University School of Public Health study being published in the December issue of the "American Journal of Public Health." The study, “Racial Differences in Cardiac Catheterization as a Function of Patients’ Beliefs”, suggests that it is physicians’ assessments and perceptions about patients that could explain the difference in care.

Racial disparities in the use of invasive cardiac procedures are widely documented, yet the reasons for such disparities remain unclear. It was commonly believed that it was patients’ attitudes and health-related beliefs that contributed to racial disparities in the use of procedures, but prior studies did not account for physician perspective. “Racial Differences in Cardiac Catheterization as a Function of Patients’ Beliefs” is the first-of-its-kind study to simultaneously evaluate patient and physician-based attitudes.

Researchers conducted their study of 1045 white and African-American patients at Department of Veterans Affairs Medical Centers in Houston, Pittsburgh, Atlanta, Durham (NC) and St. Louis and noted few demographic differences between them. African Americans were more likely than whites to indicate a strong reliance on religion and to report racial and social class discrimination and less likely to indicate a generalized trust in people. There was little discernible difference between African-American and white patients on numerous other attitudes toward health and health care.

According to researcher Nancy Kressin, PhD, Boston University School of Public Health, “We did not find that patients' attitudes and beliefs explained the observed disparities in receipt of cardiac catheterization; but physicians’ assessments of the importance of cardiac catheterization for each patient, and of the patient's likelihood of coronary disease, did seem to account for the racial differences in procedure use.” These results suggest that interventions aimed at decreasing differences in physicians’ evaluations of white and African-American patients may help decrease disparities in cardiac care. For example, researchers suggest that to the extent that physicians evaluate white and African-American patients differently, computerized decision aids provided to physicians at the point of care and that offer objective and accurate information might help reduce this source of disparity.

“The continued existence of racial disparities in the use of cardiac procedures is troubling, especially when observed in an equal-access system. Raising physicians’ consciousness about the possibility of bias through cultural competency training may help decrease the use of racially based clinical stereotypes,” says Kressin.

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