Abstract 15581: No Evidence of Racial/Ethnic Disparities in the Noninvasive Evaluation of Patients for Coronary Heart Disease in the United States
Introduction: Racial and ethnic disparities in the diagnosis and treatment of cardiovascular disease and its risk factors are widely recognized, and reducing the burden of these disparities was a major focus of Healthy People 2010. While differences in cholesterol screening, hypertension treatment, and cardiac revascularization have been reported, it is unknown whether disparities exist in the utilization of cardiac stress testing to diagnose CHD.
Hypothesis: Nonwhite patients at risk for CHD are less likely to receive stress testing than white patients.
Method: We analyzed a nationally representative US sample of 452,188 adult ambulatory visits from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 1995 to 1999 (prior to the Jan. 2000 launch of Healthy People 2010) and 2006-2010 (after the launch). Patients with CHD were excluded. The main outcome was survey-weighted incidence of referrals for or performance of stress testing. Multivariable logistic regressions included ethnicity (Hispanic, non-Hispanic white, and non-Hispanic black), an ethnicity-gender interaction, clinical risk factors (smoking, diabetes, dyslipidemia, and hypertension), whether the patient’s reason for visiting the physician was chest pain, physician specialty, sociodemographics, geographic location, and insurance status.
Result: Stress testing was ordered or performed in 37 per 10,000 adult ambulatory visits in 1995-1999 and 47 per 10,000 visits in 2006-2010. In unadjusted and adjusted analyses, patients who were Hispanic or black were no more or less likely to undergo stress testing than white patients, either in the pre- (adjusted OR 0.7, CI 0.4-1.2 for Hispanics; aOR 0.9, 0.5-1.4 for blacks) or post-period (aOR 1.0, 0.7-1.4 for Hispanics; aOR 0.9, 0.5-1.5 for blacks). Similarly, no significant differences were found when we examined stress testing with imaging or ethnicity-gender interactions.
Conclusion: Racial/ethnic disparities that have previously been reported in the utilization of preventive and therapeutic cardiovascular interventions do not appear to extend to cardiac stress testing. However, reducing disparities in the burden of cardiovascular disease remains an important concern.
- © 2013 by American Heart Association, Inc.