title: Racial differences in cardiac catheterization as a function of patients' beliefs.
abstract: OBJECTIVE
  We examined racial differences in cardiac catheterization rates and reviewed whether patients' beliefs or other variables were associated with observed disparities.
  
  
  METHODS
  We did a prospective observational cohort study of 1045 White and African American patients at 5 Veterans Affairs (VA) medical centers whose nuclear imaging studies indicated reversible cardiac ischemia.
  
  
  RESULTS
  There were few demographic differences between White and African American patients in our sample. African Americans were less likely than Whites to undergo cardiac catheterization. African Americans were more likely than Whites to indicate a strong reliance on religion and to report racial and social class discrimination and were less likely to indicate a generalized trust in people but did not differ from White patients on numerous other attitudes about health and health care. Neither sociodemographic or clinical characteristics nor patients' beliefs explained the observed disparities, but physicians' assessments of the procedure's importance and patients' likelihood of coronary disease seemed to account for differences not otherwise explained.
  
  
  CONCLUSIONS
  Patients' preferences are not the likely source of racial disparities in the use of cardiac catheterization among veterans using VA care, but physicians' assessments warrant further attention.
authors.affiliation: Center for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Medical Center, Bedford, MA 01730, USA. nkressin@bu.edu
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Kressin
authors.forename: Bei-Hung
authors.initials: BH
authors.lastname: Chang
authors.forename: Jeff
authors.initials: J
authors.lastname: Whittle
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Jack A
authors.initials: JA
authors.lastname: Clark
authors.forename: Amy K
authors.initials: AK
authors.lastname: Rosen
authors.forename: Michelle
authors.initials: M
authors.lastname: Orner
authors.forename: Tracie C
authors.initials: TC
authors.lastname: Collins
authors.forename: Linda G
authors.initials: LG
authors.lastname: Alley
authors.forename: Laura A
authors.initials: LA
authors.lastname: Petersen
mesh_terms: D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D006328:Cardiac Catheterization / Q000523:psychology / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology; D017060:Patient Satisfaction; D010820:Physicians / Q000523:psychology; D012959:Socioeconomic Factors; D044465:White People / Q000523:psychology* / Q000706:statistics & numerical data