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Emergency departments test chest pain patients differently, based on race, gender and insurance

February 02, 2007

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.

Chest pain is the most common initial symptom in patients diagnosed with coronary artery disease. Tests such as electrocardiography, chest radiography as well as oxygen saturation monitoring and cardiac monitoring are non-invasive and useful in diagnosing the disease. The study found that these tests are applied differently based on patients' race, gender and insurance.

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 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.

Medical College of Wisconsin