Disparities in the emergency department evaluation of chest pain patients. Acad Emerg Med 2007 Feb;14(2):149-56
Date
02/03/2007Pubmed ID
17267531DOI
10.1197/j.aem.2006.08.020Scopus ID
2-s2.0-33846416255 (requires institutional sign-in at Scopus site) 62 CitationsAbstract
BACKGROUND: The existence of race and gender differences in the provision of cardiovascular health care has been increasingly recognized. However, few studies have examined whether these differences exist in the emergency department (ED) setting.
OBJECTIVES: To evaluate race, gender, and insurance differences in the receipt of early, noninvasive diagnostic tests among persons presenting to an ED with a complaint of chest pain.
METHODS: Data were drawn from the U.S. National Hospital Ambulatory Health Care Survey of EDs. Visits made during 1995-2000 by persons aged 30 years or older with chest pain as a reason for the visit were included. Factors affecting the likelihood of ordering electrocardiography, cardiac monitoring, oxygen saturation measurement using pulse oximetry, and chest radiography were analyzed using multivariate probit analysis.
RESULTS: A total of 7,068 persons aged 30 years or older presented to an ED with a primary complaint of chest pain during the six-year period, corresponding to more than 32 million such visits nationally. The adjusted probability of ordering a test was highest for non-African American patients for all tests considered. African American men had the lowest probabilities (74.3% and 62% for electrocardiography and chest radiography, respectively), compared with 81.1% and 70.3%, respectively, among non-African American men. Only 37.5% of African American women received cardiac monitoring, compared with 54.5% of non-African American men. Similarly, African American women were significantly less likely than non-African American men to have their oxygen saturation measured. Patients who were uninsured or self-pay, as well as patients with "other" insurance, also had a lower probability than insured persons of having these tests ordered.
CONCLUSIONS: This study documents race, gender, and insurance differences in the provision of electrocardiography and chest radiography testing as well as cardiac rhythm and oxygen saturation monitoring in patients presenting with chest pain. These observed differences should catalyze further study into the underlying causes of disparities in cardiac care at an earlier point of patient contact with the health care system.
Author List
Pezzin LE, Keyl PM, Green GBAuthor
Liliana Pezzin PhD, JD Professor in the Institute for Health and Equity department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultChest Pain
Electrocardiography
Emergency Service, Hospital
Female
Humans
Insurance, Health
Male
Middle Aged
Oximetry
Probability
Quality of Health Care
Radiography
Retrospective Studies
Sex Factors
United States
