title: Race differences in cardiac catheterization: the role of social contextual variables.
abstract: 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.
authors.affiliation: Center for Organizational, Leadership, and Management Research, VA Boston Healthcare System, Boston, MA, USA. brian.ayotte@va.gov
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Ayotte
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Kressin
mesh_terms: 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*
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