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Senior Citizen Health & Medicine
Race, Gender, Insurance Bias Found in Emergency Care
for Chest Pain
African American men were 25-30% less likely to
receive needed tests
February 4, 2007 – Being an African American
without commercial health insurance is not good for those who go to an
emergency with chest pain, the most common initial symptom in patients
diagnosed with coronary artery disease. The problem is that the testing
to determine if the chest pain is caused by coronary artery disease is
applied differently by race, gender and insurance, says a new study.
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Health & Medicine |
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Tests such as electrocardiography, chest
radiography as well as oxygen saturation monitoring and cardiac
monitoring are non-invasive and useful in diagnosing the disease.
Researchers drew on data compiled by the National
Hospital Ambulatory Health Care Survey of Emergency Departments (NHAMCS-ED),
from 1995 to 2000, for patients 30 years old or older presenting with
chest pain. The retrospective study used a sample of 7,068 patients
which corresponded to 32 million visits nationally throughout the
six-year period.
They found that the rate of visits to emergency
departments by patients presenting with chest pain increased in the
six-year period, and that race, gender and insurance differences were
factors in the type of care patients received at emergency departments.
Overall, African American males were 25 to 30
percent less likely to receive any of the tests than non-African
American males.
Use of all forms of diagnostic testing and
monitoring - with the exception of oxygen saturation monitoring -
decreased among male African American patients over the six-year period.
Electrocardiography decreased more than 16 percent among male African
American patients, and they were 26 percent less likely to be placed on
cardiac monitoring in 2000 than they were in 1995.
Gender was also an issue in determining what tests
are administered for patients presenting with chest pain. African
American women were approximately five percent less likely to have
electrocardiography tests than non-African American men.
African American women were also 17 percent less
likely to undergo cardiac monitoring, 14 percent less likely to have
oxygen saturation monitoring, and six percent less likely to have chest
radiography tests than non-African American men. Similarly, the rate of
testing was lower for non-African American women than it was for
non-African American men.
Insurance type was also proven to have a
significant role in the administration of tests. Patients covered by
forms of insurance other than commercial insurance, like government
programs, were approximately 13 percent less likely to undergo
electrocardiography.
Additionally, patients covered by these forms of
insurance were almost 21 percent less likely to be placed on cardiac
monitoring, 23 percent less likely to have oxygen saturation measured,
and more than 13 percent less likely to receive chest radiography than
patients covered by commercial insurance.
The study also found that approximately 82 percent
of commercially insured non-African American men received
electrocardiography testing when presenting with chest pain in 2000.
This is nearly a 27 percent higher proportion than uninsured African
American men, and a 31 percent higher proportion than African American
men covered by non-commercial forms of insurance.
The study, conducted by Liliana E. Pezzin, Ph.D.,
associate professor of medicine at the Medical College, along with
co-investigators Gary B. Green, M.D., MPH, and Penelope Keyl, Ph.D., at
Johns Hopkins, appears in the February 2007 issue of Academic Emergency
Medicine.
The study was funded, in part, by a grant from the
Agency for Healthcare Research and Quality.
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