Race differences in cardiac catheterization: the role of social contextual variables.
BACKGROUND
Race differences in the receipt of invasive cardiac procedures are well-documented but the etiology remains poorly understood.


OBJECTIVE
We examined how social contextual variables were related to race differences in the likelihood of receiving cardiac catheterization in a sample of veterans who were recommended to undergo the procedure by a physician.


METHODS
Prospective observational cohort study.


METHODS
A subsample from a study examining race disparities in cardiac catheterization of 48 Black/African American and 189 White veterans who were recommended by a physician to undergo cardiac catheterization.


METHODS
We assessed social contextual variables (e.g., knowing somebody who had the procedure, being encouraged by family or friends), clinical variables (e.g., hypertension, maximal medical therapy), and if participants received cardiac catheterization at any point during the study.


RESULTS
Blacks/African Americans were less likely to undergo cardiac catheterization compared to Whites even after controlling for age, education, and clinical variables (OR = 0.31; 95% CI, 0.13, 0.75). After controlling for demographic and clinical variables, three social contextual variables were significantly related to increased likelihood of receiving catheterization: knowing someone who had undergone the procedure (OR = 3.14; 95% CI, 1.70, 8.74), social support (OR = 2.05; 95% CI, 1.17, 2.78), and being encouraged by family to have procedure (OR = 1.45; 95% CI, 1.08, 1.90). After adding the social contextual variables, race was no longer significantly related to the likelihood of receiving catheterization, thus suggesting that social context plays an important role in the relationship between race and cardiac catheterization.


CONCLUSIONS
Our results suggest that social contextual factors are related to the likelihood of receiving recommended care. In addition, accounting for these relationships attenuated the observed race disparities between Whites and Blacks/African Americans who were recommended to undergo cardiac catheterization by their physicians.
Ayotte
Brian J
BJ
Center for Organizational, Leadership, and Management Research, VA Boston Healthcare System, Boston, MA, USA. brian.ayotte@va.gov
Kressin
Nancy R
NR
D001741:Black or African American / Q000706:statistics & numerical data*; D006328:Cardiac Catheterization / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D003710:Demography; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities; D006801:Humans; D007398:Interpersonal Relations; D016015:Logistic Models; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D016017:Odds Ratio; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011446:Prospective Studies; D012372:ROC Curve; D012931:Social Environment; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D044465:White People / Q000706:statistics & numerical data*
Am J Public Health. 1986 Dec;76(12):1446-8
3490796
Arch Intern Med. 1998 Jul 13;158(13):1450-3
9665355
J Am Coll Cardiol. 1999 Jun;33(7):2092-197
10362225
Med Care. 2002 Jan;40(1 Suppl):I72-85
11789634
Med Care Res Rev. 2007 Oct;64(5 Suppl):29S-100S
17881625
J Clin Oncol. 2003 Apr 1;21(7):1379-82
12663730
J Gerontol B Psychol Sci Soc Sci. 2006 May;61(3):S140-6
16670191
JAMA. 1992 Jan 22-29;267(4):520-4
1729574
Med Care. 2002 Jan;40(1 Suppl):I27-34
11789628
N Engl J Med. 2002 Nov 14;347(20):1585-92
12432046
J Clin Epidemiol. 1997 Aug;50(8):899-901
9291874
J Am Coll Cardiol. 1999 May;33(6):1756-824
10334456
Public Health Nurs. 1992 Dec;9(4):242-7
1484814
J Gen Intern Med. 1997 May;12(5):267-73
9159695
J Vasc Surg. 2004 Jul;40(1):86-91
15218467
J Gen Intern Med. 2004 Sep;19(9):962-6
15333061
J Gerontol B Psychol Sci Soc Sci. 2002 Nov;57(6):S332-47
12426442
Am J Public Health. 2004 Dec;94(12):2091-7
15569959
Spine (Phila Pa 1976). 2006 Sep 1;31(19):2263-9
16946665
J Behav Med. 2009 Feb;32(1):48-63
19127421
Clin Gastroenterol Hepatol. 2007 Nov;5(11):1306-12
17689294