Racial and gender differences seen in ER evaluation of chest pain
NEW YORK (Reuters Health) - African-American patients who present to the ER for chest pain are less likely to receive standard tests, such electrocardiography and chest radiography, than patients from other racial groups, new research shows. The findings also suggest differences in chest pain evaluation based on gender and insurance status.
"A number of studies have looked at racial and gender differences" in the provision of cardiovascular treatments, lead author Dr. Liliana E. Pezzin, from the Medical College of Wisconsin in Milwaukee, told Reuters Health. However, "few studies have examined how race, gender, and insurance status may affect the evaluation of chest pain in the ER setting."
The present study, reported in the February issue of Academic Emergency Medicine, involved 7,068 patients, drawn from a national database, who presented to the ER with a primary complaint of chest pain between 1995 and 2000.
African-American patients were less likely than non-African-Americans to be evaluated with electrocardiography, chest x-ray, cardiac monitoring, and pulse oximetry.
African-American men had the lowest rates of electrocardiography and chest radiography usage, 74.3% and 62.0%, respectively. The corresponding rates in non-African-American men were 81.1% and 70.3%.
African-American women had the lowest rates of cardiac monitoring and pulse oximetry, 37.5% and 41.8%, respectively. The corresponding rates in non-African-American men were 54.5% and 55.8%.
Insurance status also seemed to influence the chest pain work-up. Uninsured, self-pay, or patients with "other" insurance were less likely to receive the tests studied than were insured patients.
A number of significant temporal changes were also observed. From 1995 to 2000, the proportion of African-American men receiving electrocardiography and cardiac monitoring fell by 16.3% and 25.9%, respectively. Use of cardiac monitoring among non-African-American women fell 20.7%, while chest radiography usage dropped by 17.6% in African-American women.
"Communications issues could play a role in the differences seen," Pezzin said. Prior studies have suggested that a physician may not communicate as effectively with someone from a different ethnic group.
However, she added that physician communication issues are probably not the sole explanation since in many ERs the tests studied are often ordered before the doctor even sees the patient. "This suggests that all people in the ER, particularly those who first see the patient, need to be aware of guidelines for evaluating chest pain."
Acad Emerg Med 2007