The effect of race and sex on physicians' recommendations for cardiac catheterization

被引:1402
作者
Schulman, KA
Berlin, JA
Harless, W
Kerner, JF
Sistrunk, S
Gersh, BJ
Dubé, R
Taleghani, CK
Burke, JE
Williams, S
Eisenberg, JM
Escarce, JJ
机构
[1] Georgetown Univ, Med Ctr, Clin Econ Res Unit, Washington, DC 20007 USA
[2] Georgetown Univ, Med Ctr, Vincent T Lombardi Canc Res Ctr, Washington, DC 20007 USA
[3] Georgetown Univ, Med Ctr, Div Gen Internal Med, Washington, DC 20007 USA
[4] Georgetown Univ, Med Ctr, Div Cardiol, Washington, DC 20007 USA
[5] Georgetown Univ, Med Ctr, Dept Med, Washington, DC 20007 USA
[6] Univ Penn, Sch Med, Ctr Clin Epidemiol & Biostat, Philadelphia, PA 19104 USA
[7] Univ Penn, Sch Med, Dept Biostat & Epidemiol, Philadelphia, PA 19104 USA
[8] Univ Penn, Sch Med, Div Gen Internal Med, Philadelphia, PA 19104 USA
[9] Interact Drama, Bethesda, MD USA
[10] RAND Hlth Program, Santa Monica, CA USA
关键词
D O I
10.1056/NEJM199902253400806
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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<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 non-anginal 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. (N Engl J Med 1999;340:618-26.) (C)1999, Massachusetts Medical Society.
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收藏
页码:618 / 626
页数:9
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