The effect of race and sex on physicians' recommendations for cardiac catheterization
The effect of race and sex on physicians' recommendations for cardiac catheterization
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DOI：
10.1056/nejm199902253400806
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发表时间：
1999-02-25
影响因子：
158.5
通讯作者：
Escarce, JJ
中科院分区：
文献类型：
--
作者：
Schulman, KA;Berlin, JA;Escarce, JJ
背景：流行病学研究已经报道了不同种族和性别患者在使用心血管手术方面的差异。这些差异是否源于医生建议的不同仍不确定。方法我们开发了一种计算机化的调查工具来评估医生对胸痛治疗的建议。演员们在有剧本的采访中描绘出具有特定特征的病人的症状。在两次全国初级保健医生组织会议上，共有720名医生参与了调查。每位医生都观看了一段采访记录，并获得了一个假想病人的其他数据。然后他或她就病人的护理提出建议。我们使用多变量logistic回归分析来评估患者的种族和性别对治疗建议的影响，同时控制医生对冠状动脉疾病概率的评估，以及患者的年龄、冠状动脉风险水平、胸痛类型和运动负荷测试结果。结果医生对女性冠状动脉疾病概率的平均（+/-SD）估计值为塔形(概率为64.1+/- 19.3%，男性为69.2+/- 18.2%
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 tower for women (probability, 64.1+/-19.3 percent, vs. 69.2+/-18.2 percent for men; P