title: The cardiac access longitudinal study. A study of access to invasive cardiology among African American and white patients.
abstract: OBJECTIVE
  We sought to identify factors contributing to racial disparity in the receipt of coronary angiography (CA).
  
  
  BACKGROUND
  Numerous studies have demonstrated that African American patients are less likely to receive needed diagnostic and therapeutic coronary procedures than white patients. This report summarizes the methods and findings of a study linking medical records with patient and physician interviews to address racial disparities in the utilization of CA.
  
  
  METHODS
  This is a retrospective, cross-sectional study conducted in three urban hospitals in Maryland. A total of 9,275 medical records were reviewed, representing all 7,058 cardiac patients admitted in a two-year period. We identified 2,623 patients who, according to American College of Cardiology guidelines, were candidates for receiving CA. A total of 1,669 patients (721 African Americans and 948 whites) and 74% of their physicians were successfully interviewed. Multivariate and hierarchical multivariate logistic regression were used to construct a model of receipt of CA within one year of the hospitalization.
  
  
  RESULTS
  The unadjusted odds of white patients receiving CA was three times greater than the odds for African American patients (odds ratio [OR] 3.0, 95% confidence interval [CI] 2.4 to 3.7). Adjusting for patients' clinical and social characteristics resulted in a 13% reduction in the OR for race. Adjusting for physician and health care system characteristics reduced the OR by 43%, to 1.7 (95% CI 1.3 to 2.4).
  
  
  CONCLUSIONS
  Racial disparity in the utilization of CA is a function of differences in the health care system "context" in which African American and white patients obtain care, combined with differences in the specific clinical characteristics of patients.
authors.affiliation: Center for Health Disparities Solutions, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. tlaveist@jhsph.edu
authors.forename: Thomas A
authors.initials: TA
authors.lastname: LaVeist
authors.forename: Melanie
authors.initials: M
authors.lastname: Arthur
authors.forename: Athol
authors.initials: A
authors.lastname: Morgan
authors.forename: Michael
authors.initials: M
authors.lastname: Rubinstein
authors.forename: Joanne
authors.initials: J
authors.lastname: Kinder
authors.forename: Linda M
authors.initials: LM
authors.lastname: Kinney
authors.forename: Stephen
authors.initials: S
authors.lastname: Plantholt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D002309:Cardiology / Q000706:statistics & numerical data*; D017023:Coronary Angiography / Q000941:ethics / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D044465:White People; D001741:Black or African American