Recent studies have found indications of gender and racial biases in the treatment of ischemic heart disease. Few studies, however, have examined Emergency Department (ED) treatments for such biases. OBJECTIVE: To determine the extent to which age, gender, and race influence the ED performance of well-established diagnostic tests--EKG, chest X-ray (CXR), pulse oxymetry (PO), and cardiac monitor (CM)--for patients presenting with symptoms suggestive of acute cardiac ischemia. DESIGN: Analysis of NHAMCS, a nationally representative sample of ED patient visits. PARTICIPANTS: Patients (unweighted n=4,113; weighted n=18,413,643) who presented to 392 EDs during 1995-1997 with a complaint of chest pain. METHODS: Multivariate logistic regression was used to control for time trends, demographics, insurance status, and hospital characteristics. RESULTS: 71% of patients presenting with CP received an EKG; 64% received a CXR; 47%, a PO and 43%, CM. Black and Hispanic patients were significantly less likely than White patients to receive any of the tests studied (OR:0.87 and 0.76 for EKG; 0.64 and 0.59 for CM; 0.67 and 0.66 for PO; 0.82 and 0.73 for CXR; p<0.05, respectively). Disparities were especially large for Black females compared with White males(OR:0.48, p<0.01 for CM; 0.66, p<0.01 for PO). With one exception (PO), females as well as uninsured and Medicaid recipients were systematically less likely than males and commercially insured patients to have tests (p<0.05). CONCLUSION: Even after controlling for confounding factors, significant racial, gender, and insurance status biases exist in the evaluation of chest pain patients in the ED.
Learning Objectives: "At the conclusion of the session, the participant (learner) in this session will be able to: 1. Describe how an analysis of national ED visit data can be used to examine treatment biases. 2. Describe race, gender, and insurance biases in the emergency department evaluations of chest pain patients in 1995-1997
Keywords: Treatment Patterns, Emergency Department/Room
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.