Race and sex differences in the refusal of cardiac catheterization among elderly patients hospitalized with acute myocardial infarction

Background Prior studies have reported race and sex differences in cardiac catheterization use after acute myocardial infarction (AMI). It is unclear whether race or sex differences in procedure refusal may contribute to this difference. We sought to determine whether cardiac catheterization refusal rates differ by patient race or sex. Methods We evaluated medical records of 74,745 Medicare beneficiaries hospitalized for AMI between January 1994 and February 1996 to ascertain refusal of cardiac catheterization during hospitalization. Patient race and sex were evaluated for their association with cardiac catheterization refusal adjusting for patient, physician, and hospital characteristics. Results The cardiac catheterization refusal rate in the overall cohort was 2.92% (95% CI 2.80%-3.04%). Race and sex differences in cardiac catheterization were observed after multivariate adjustment, with white women (odds ratio [OR] 1.28), black men (OR 1.34), and black women (OR 1.37) more likely to refuse cardiac catheterization than white men (OR 1.00). Relative differences in refusal were associated with only modest absolute differences in risk-standardized rates of cardiac catheterization refusal; rates were lowest for white men (2.55%), and higher for white women (3.21%), black men (3.36%), and black women (3.38%, P <.001 for global comparison). Conclusions Patient race and sex were associated with cardiac catheterization refusal among elderly patients hospitalized with AMI. However, absolute race and sex differences in rates of procedure refusal were small, suggesting that race and sex differences in cardiac catheterization refusal provide only a partial explanation of observed differences in cardiac procedure use.