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Cited by 1,934Sex and Gender in HealthcareDiversity and Career in MedicineCardiac Imaging and Diagnostics

The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catheterization

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Schulman, Kevin A., Berlin, Jesse A., Harless, William, Kerner, Jon F., Sistrunk, Shyrl, Gersh, Bernard J., Dubé, Ross, Taleghani, Christopher K. +5 more·1999·New England Journal of Medicine
DOI 10.1056/nejm199902253400806
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Abstract

BACKGROUND: Epidemiologic studies have reported differences in the use of cardiovascular procedures according to the race and sex of the patient. Whether the differences stem from differences in the recommendations of physicians remains uncertain. METHODS: We developed a computerized survey instrument to assess physicians' recommendations for managing chest pain. Actors portrayed patients with particular characteristics in scripted interviews about their symptoms. A total of 720 physicians at two national meetings of organizations of primary care physicians participated in the survey. Each physician viewed a recorded interview and was given other data about a hypothetical patient. He or she then made recommendations about that patient's care. We used multivariate logistic-regression analysis to assess the effects of the race and sex of the patients on treatment recommendations, while controlling for the physicians' assessment of the probability of coronary artery disease as well as for the age of the patient, the level of coronary risk, the type of chest pain, and the results of an exercise stress test. RESULTS: The physicians' mean (+/-SD) estimates of the probability of coronary artery disease were lower for women (probability, 64.1+/-19.3 percent, vs. 69.2+/-18.2 percent for men; P<0.001), younger patients (63.8+/-19.5 percent for patients who were 55 years old, vs. 69.5+/-17.9 percent for patients who were 70 years old; P<0.001), and patients with nonanginal pain (58.3+/-19.0 percent, vs. 64.4+/-18.3 percent for patients with possible angina and 77.1+/-14.0 percent for those with definite angina; P=0.001). Logistic-regression analysis indicated that women (odds ratio, 0.60; 95 percent confidence interval, 0.4 to 0.9; P=0.02) and blacks (odds ratio, 0.60; 95 percent confidence interval, 0.4 to 0.9; P=0.02) were less likely to be referred for cardiac catheterization than men and whites, respectively. Analysis of race-sex interactions showed that black women were significantly less likely to be referred for catheterization than white men (odds ratio, 0.4; 95 percent confidence interval, 0.2 to 0.7; P=0.004). CONCLUSIONS: Our findings suggest that the race and sex of a patient independently influence how physicians manage chest pain.

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  • Promoting awareness of the social and historical context of race, the evidence documenting racial disparities in the quality of health care, and the evidence that provider bias may contribute to those disparities may help nurture internal motivation to reduce bias based on a sense of fairness.

    “Promoting awareness of the social and historical context of race, the evidence documenting racial disparities in the quality of health care,2 and the evidence that provider bias may contribute to those disparities15 may also help in nurturing internal motivation to reduce bias, based on a sense of fairness.”

    From Reducing Racial Bias Among Health Care Providers: Lessons from Social-Cognitive Psychology (2007) · cites this paper as [15]

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Authors
Schulman, K. A., Berlin, J. A., Harless, W., Kerner, J. F., Sistrunk, S., Gersh, B. J., Dubé, R., Taleghani, C. K., Burke, J. E., Williams, S., Eisenberg, J. M., Ayers, W., & Escarce, J. J.
Affiliations
  • Georgetown University Medical Center (US)
  • Interactive Drama (United States) (US)
  • Georgetown Lombardi Comprehensive Cancer Center (US)
  • University of Pennsylvania (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
1999-02-25
Volume
340
Issue
8
Pages
618-626
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm199902253400806
OpenAlex
W2001371486
Cited by
1,934
References
37
Citations by year
2026: 18 · 2025: 39 · 2024: 47 · 2023: 62 · 2022: 74 · 2021: 68 · 2020: 79 · 2019: 58 · 2018: 56 · 2017: 40 · 2016: 60 · 2015: 52 · 2014: 60 · 2013: 59 · 2012: 68
FWCI
123.81
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • University Libraries (University of Maryland) (submittedVersion)
  • DigitalGeorgetown (Georgetown University Library) (submittedVersion)
  • Digital Repository at the University of Maryland (University of Maryland College Park)
Funders
Agency for Healthcare Research and Quality (HS07315)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
  • Social Sciences › Gender Studies › Diversity and Career in Medicine
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
Keywords
cardiac catheterization, physician referral, racial disparities, sex differences, coronary artery disease, chest pain, Black women, gender bias in medicine, racial bias in medicine, coronary risk assessment, angina pectoris, exercise stress testing, primary care physicians, health care disparities
MeSH terms
Age Factors, Aged, Angina Pectoris, Attitude of Health Personnel, Chest Pain, Coronary Disease, Data Collection, Decision Making, Female, Cardiac Catheterization, Humans, Male, Middle Aged, Physicians, Physicians, Family, Primary Health Care, Sex Factors, Logistic Models, Patient Selection, Black People, White People

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