title: Diagnoses, symptoms, and attribution of symptoms among black and white inpatients admitted for coronary heart disease.
abstract: OBJECTIVE
  This study examined health care-seeking behaviors to elucidate factors that contribute to differences in patterns of coronary heart disease between African Americans and Whites. The prevalence of diagnosed coronary heart disease, patients' perceptions of symptoms and attribution of symptoms, and predictors of painful symptoms and attribution of cardiac symptoms were examined.
  
  
  METHODS
  The study involved 2416 patients admitted with diagnoses of coronary artery disease, ischemic heart disease, or myocardial infarction or to rule out myocardial infarction. Structured interview questions were used to obtain demographic information, symptoms precipitating admission, and patients' attribution of their symptoms. Discharge diagnoses were obtained from hospital records.
  
  
  RESULTS
  Acute myocardial infarction, unstable angina, nonacute ischemic heart disease, and atherosclerosis were more frequent in White patients. For Blacks, the odds of reporting painful symptoms were only 64% of the odds found for Whites when other factors were controlled, and the odds of attributing symptoms to cardiac origins were almost 50% lower for Blacks than for Whites.
  
  
  CONCLUSIONS
  The tendency of Blacks to report fewer painful symptoms and to attribute their symptoms to noncardiac origins may contribute to differences in care-seeking and in medical management of heart disease in Blacks.
authors.affiliation: School of Medicine, University of Alabama at Birmingham.
authors.forename: J M
authors.initials: JM
authors.lastname: Raczynski
authors.forename: H
authors.initials: H
authors.lastname: Taylor
authors.forename: G
authors.initials: G
authors.lastname: Cutter
authors.forename: M
authors.initials: M
authors.lastname: Hardin
authors.forename: N
authors.initials: N
authors.lastname: Rappaport
authors.forename: A
authors.initials: A
authors.lastname: Oberman
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000407:Alabama / Q000453:epidemiology; D003327:Coronary Disease / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy; D010342:Patient Acceptance of Health Care; D044465:White People / Q000706:statistics & numerical data