The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catheterization

Schulman, Kevin A.; Berlin, Jesse A.; Harless, William G.; Kerner, Jon; Sistrunk, Shyrl; Gersh, Bernard J.; Dube, Ross; Taleghani, Christopher K.; Burke, Jennifer E.; Williams, Sankey V.; Eisenberg, John M.; Escarce, José J.

doi:10.1056/nejm199902253400806

Cited by 1,707 publications

(1,071 citation statements)

References 39 publications

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“…Contrary to our findings, they saw increased disparity in limb loss for black patients living in wealthier areas even though there was an overall increase in the likelihood of receiving revascularization for all patients residing in wealthier ZIP codes 7. Provider bias, influenced by race, in the management of cardiovascular disease has been described in the literature 30, 31. We found that black patients had lower rates of prescriptions for statins and antiplatelet agents in our cohort compared with white patients.…”

Section: Discussioncontrasting

confidence: 99%

Race and Socioeconomic Status Independently Affect Risk of Major Amputation in Peripheral Artery Disease

Arya

Binney

Khakharia

et al. 2018

JAHA

171

117

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BackgroundBlack race has been shown to be a risk factor for amputation in peripheral artery disease (PAD); however, race has been argued to be a marker for socioeconomic status (SES) rather than true disparity. The aim of this study is to study the impact of race and SES on amputation risk in PAD patients.Methods and ResultsPatients with incident PAD in the national Veterans Affairs Corporate Data Warehouse were identified from 2003 to 2014 (N=155 647). The exposures were race and SES (measured by median income in residential ZIP codes). The outcome was incident major amputation. Black veterans were significantly more likely to live in low‐SES neighborhoods and to present with advanced PAD. Black patients had a higher amputation risk in each SES stratum compared with white patients. In Cox models (adjusting for covariates), black race was associated with a 37% higher amputation risk compared with white race (hazard ratio: 1.37; 95% confidence interval, 1.30–1.45), whereas low SES was independently predictive of increased risk of amputation (hazard ratio: 1.12; 95% confidence interval, 1.06–1.17) and showed no evidence of interaction with race. In predicted amputation risk analysis, black race and low SES continued to be significant risk factors for amputation regardless of PAD presentation.ConclusionsBlack race significantly increases the risk of amputation within the same SES stratum compared with white race and has an independent effect on limb loss after controlling for comorbidities, severity of PAD at presentation, and use of medications.

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Section: Discussioncontrasting

confidence: 99%

Race and Socioeconomic Status Independently Affect Risk of Major Amputation in Peripheral Artery Disease

Arya

Binney

Khakharia

et al. 2018

JAHA

171

117

View full text Add to dashboard Cite

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“…Even the most well-meaning and egalitarian physicians may have stereotypes or biases based on a patient's demographic status (Burgess, Fu & Van Ryn, 2004;Van Ryn, Burgess, Malat & Griffin, 2006). Racial bias, in particular, has been implicated in research showing that some physicians associate more negative attributes (e.g., non-compliant, less intelligent, more likely to abuse drugs and alcohol) to minority and less educated patients (Van Ryn & Burke, 2000), perceptions that in turn may affect physicians' informativeness (Amir, 1987) and medical decision-making (Krupat, Irish, Kasten, Freund, Burns, Moskowitz et al 1999;Schulman, Berlin, Harless, Kerner, Sistrunk, Gersh et al 1999). Such findings have led some to explore whether demographic concordance between physician and patient may facilitate better relationships and more positive health care interactions because the physician and patient have some element of shared identity.…”

Section: Conceptual Framework: An Ecological Approachmentioning

confidence: 99%

Physicians’ communication and perceptions of patients: Is it how they look, how they talk, or is it just the doctor?

Street

Gordon

Haidet

2007

Social Science & Medicine

451

359

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Although physicians' communication style and perceptions affect outcomes, few studies have examined how these perceptions relate to the way physicians communicate with patients. Moreover, while any number of factors may affect the communication process, few studies have analyzed these effects collectively in order to identify the most powerful influences on physician communication and perceptions. Adopting an ecological approach, this investigation examined: (a) the relationships of physicians' patient-centered communication (informative, supportive, partnership-building) and affect (positive, contentious) on their perceptions of the patient, and (b) the degree to which communication and perceptions were affected by the physicians' characteristics, patients' demographic characteristics, physician-patient concordance, and the patient's communication. Physicians (N = 29) and patients (N = 207) from 10 outpatient settings in the United States participated in the study. From audio-recordings of these visits, coders rated the physicians' communication and affect as well as the patients' participation and affect. Doctors were more patientcentered with patients they perceived as better communicators, more satisfied, and more likely to adhere. Physicians displayed more patient-centered communication and more favorably perceived patients who expressed positive affect, were more involved, and who were less contentious. Physicians were more contentious with black patients, whom they also perceived as less effective communicators and less satisfied. Finally, physicians who reported a patient-centered orientation to the doctor-patient relationship also were more patient-centered in their communication. The results suggest that reciprocity and mutual influence have a strong effect on these interactions in that more positive (or negative) communication from one participant leads to similar responses from the other. Physicians' encounters with black patients revealed communicative difficulties that may lower quality of care for these patients.

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“…Furthermore, the receipt of cardiac catheterization and specialty care for patients presenting at nonmetropolitan hospitals without these services often requires transfer to centers located in metropolitan areas. Financial barriers,7, 8 intrinsic physician bias,16 and other factors may result in differential receipt of these services based on area median income. Few studies have examined specifically whether location of care modifies the association among area median income and access to cardiac catheterization and outcomes of ACS 9.…”

Section: Introductionmentioning

confidence: 99%

Area Median Income and Metropolitan Versus Nonmetropolitan Location of Care for Acute Coronary Syndromes: A Complex Interaction of Social Determinants

Fabreau

Leung

Southern

et al. 2016

JAHA

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BackgroundMetropolitan versus nonmetropolitan status and area median income may independently affect care for and outcomes of acute coronary syndromes. We sought to determine whether location of care modifies the association among area income, receipt of cardiac catheterization, and mortality following an acute coronary syndrome in a universal health care system.Methods and ResultsWe studied a cohort of 14 012 acute coronary syndrome patients admitted to cardiology services between April 18, 2004, and December 31, 2011, in southern Alberta, Canada. We used multivariable logistic regression to determine the odds of cardiac catheterization within 1 day and 7 days of admission and the odds of 30‐day and 1‐year mortality according to area median household income quintile for patients presenting at metropolitan and nonmetropolitan hospitals. In models adjusting for area income, patients who presented at nonmetropolitan facilities had lower adjusted odds of receiving cardiac catheterization within 1 day of admission (odds ratio 0.22, 95% CI 0.11–0.46, P<0.001). Among nonmetropolitan patients, when examined by socioeconomic status, each incremental decrease in income quintile was associated with 10% lower adjusted odds of receiving cardiac catheterization within 7 days (P<0.001) and 24% higher adjusted odds of 30‐day mortality (P=0.008) but no significant difference for 1‐year mortality (P=0.12). There were no differences in adjusted mortality among metropolitan patients.ConclusionWithin a universal health care system, the association among area income and receipt of cardiac catheterization and 30‐day mortality differed depending on the location of initial medical care for acute coronary syndromes. Care protocols are required to improve access to care and outcomes in patients from low‐income nonmetropolitan communities.

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The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catheterization

Abstract: Our findings suggest that the race and sex of a patient independently influence how physicians manage chest pain.

Cited by 1,707 publications

References 39 publications

Race and Socioeconomic Status Independently Affect Risk of Major Amputation in Peripheral Artery Disease

Race and Socioeconomic Status Independently Affect Risk of Major Amputation in Peripheral Artery Disease

Physicians’ communication and perceptions of patients: Is it how they look, how they talk, or is it just the doctor?

Area Median Income and Metropolitan Versus Nonmetropolitan Location of Care for Acute Coronary Syndromes: A Complex Interaction of Social Determinants

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