Black males are more prone to high blood pressure and heart disease than whites, but are 25 to 30 percent less likely to receive any basic heart monitoring tests in the emergency room.
A new study by researchers at the Medical College of Wisconsin and Johns Hopkins University shows emergency departments test chest pain patients differently, based on nonmedical factors such as race, gender and insurance.
Chest pain is the most common first symptom in patients diagnosed with coronary artery disease. Tests such as electrocardiography, chest radiography, oxygen saturation monitoring and cardiac monitoring are noninvasive and useful in disease diagnosis and getting quick treatment, according to the study published in Academic Emergency Medicine?s February 2007 issue.
“We found there were significant disparities in the use of these tests based on race and based on gender and based on insurance,” co-investigator Dr. Gary B. Green said.
Nurses and technicians administer most of these simple tests before the patient sees a doctor, Green said.
“I don?t think we?re looking at overt sexism and racism, though these things do exist,” he said. He recommended active monitoring of treatment by each hospital to combat pervasive unconscious bias in the emergency room.
Drawing on a national database compiled by the National Hospital Ambulatory Health Care Survey of Emergency Departments, they looked at patients 30 years old or older with chest pain from 1995 to 2000. The retrospective study used a sample of 7,068 patients which corresponded to 32 million national visits throughout the six-year period.
While the number of patients reporting to emergency departments with chest pain increased, use of most forms of diagnostic testing and monitoring decreased among black men.
Electrocardiography dropped more than 16 percent, and black males were 26 percent less likely to need a heart monitor in 2000 than they were in 1995.
Gender also played a role.
Black women were approximately 5 percent less likely to have electrocardiography and 17 percent less likely to undergo heart monitoring, 14 percent less likely to have oxygen saturation monitoring and six percent less likely to have chest radiography tests than nonblack men.
A third type of discrimination is apparently aimed at patient wallets, the so-called “wallet biopsy.”
Patients covered by private insurance or paying out of pocket were less likely to undergo electrocardiography, 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, according to the survey.
