The cardiac access longitudinal study - A study of access to invasive cardiology among African American and white patients
The cardiac access longitudinal study - A study of access to invasive cardiology among African American and white patients
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DOI：
10.1016/s0735-1097(03)00042-1
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发表时间：
2003-04-02
影响因子：
24
通讯作者：
Plantholt, S
中科院分区：
文献类型：
--
作者：
LaVeist, TA;Arthur, M;Plantholt, S
我们试图找出导致种族差异的因素。许多研究已经证明，非裔美国人患者比白色患者更不可能接受所需的诊断和治疗性冠状动脉手术。本报告总结了一项研究的方法和结果，将病历与患者和医生的访谈联系起来，以解决CA的利用率的种族差异。方法这是一项回顾性，横断面研究，在马里兰州的三家城市医院进行。共审查了9,275份医疗记录，代表了两年期间收治的所有7,058名心脏病患者。我们确定了2,623名患者，根据美国心脏病学会指南，他们是接受CA的候选人。共有1，669名患者（721名非洲裔美国人和948名白人）和74%的医生成功接受了采访。采用多因素和多因素Logistic回归分析，建立住院一年内接受CA的模型。结果：接受CA的白色患者的未校正比值比非洲裔美国人患者的比值大3倍（比值比[OR] 3.0，95%置信区间[CI] 2.4 - 3.7）。调整患者的临床和社会特征导致种族的OR降低13%。调整医生和医疗保健系统的特点减少了43%，OR为1.7（95%CI 1.3至2.4）。结论种族差异在利用CA是一个功能的差异，在医疗保健系统的“上下文”，非洲裔美国人和白色患者获得护理，结合患者的具体临床特征的差异。
OBJECTIVES We sought to identify factors contributing to racial disparity in. the receipt of coronary angiography (CA).BACKGROUND Numerous studies have demonstrated that African American patients are less likely to receive needed diagnostic and therapeutic coronary procedures than white patients. This report summarizes the methods and findings of a study linking medical records with patient and physician interviews to address racial disparities in the utilization of CA.METHODS This is a retrospective, cross-sectional study conducted in three urban hospitals in Maryland. A total of 9,275 medical records were reviewed, representing all 7,058 cardiac patients admitted in a two-year period. We identified 2,623 patients who, according to American College of Cardiology guidelines, were candidates for receiving CA. A total of 1,669 patients (721 African Americans and 948 whites) and 74% of their physicians were successfully interviewed. Multivariate and hierarchical multivariate logistic regression were used to construct a model of receipt of CA within one year of the hospitalization. RESULTS The unadjusted odds of white patients receiving CA was three times greater than the odds for African American patients (odds ratio [OR] 3.0, 95% confidence interval [CI] 2.4 to 3.7). Adjusting for patients' clinical and social characteristics resulted in a 13% reduction in the OR for race. Adjusting for physician and health care system characteristics reduced the OR by 43%, to 1.7 (95% CI 1.3 to 2.4).CONCLUSIONS Racial disparity in the utilization of CA is a function of differences in the health care system "context" in which African American and white patients obtain care, combined with differences in the specific clinical characteristics of patients.