Do Physicians Attend to Base Rates? Prevalence Data and Statistical Discrimination in the Diagnosis of Coronary Heart Disease
Open accessAbstract
Objective. To examine whether physicians attend to gender prevalence data in diagnostic decision making for coronary heart disease (CHD) and to test the hypothesis that previously reported gender differences in CHD diagnostic certainty are due to discrimination arising from reliance on prevalence data (“statistical discrimination”). Data Sources. A vignette‐based experiment of 256 randomly sampled primary care physicians conducted from 2006 to 2007. Study Design. Factorial experiment. Physicians observed patient presentations of cardinal CHD symptoms, standardized across design factors (gender, race, age, socioeconomic status). Data Collection. Structured interview. Principal Findings. Most physicians perceived the U.S. population CHD prevalence as higher in men (48.4 percent) or similar by gender (44.9 percent). For the observed patient, 52 percent did not change their CHD diagnostic certainty based on patient gender. Forty‐eight percent of physicians were inconsistent in their population‐level and individual‐level CHD assessments. Physicians' assessments of CHD prevalence did not attenuate the observed gender effect in diagnostic certainty for the individual patient. Conclusions. Given an adequate presentation of CHD symptoms, physicians may deviate from their prevalence data during diagnostic decision making. Physicians' priors on CHD prevalence did not explain the gender effect in CHD certainty. Future research should examine personal stereotypes as an explanation for gender differences.
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There was no evidence to support the theory of statistical discrimination as an explanation for why physicians were less certain of their diagnoses of CHD in women.
“There was no evidence to support the theory of statistical discrimination as an explanation for why physicians were less certain of their diagnoses of CHD in women [36].”
From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [36]
One study found that 48% of physicians were inconsistent in their population-level and individual level assessments and that the physicians' gender-based population prevalence assessments were not associated with the certainty of their diagnosis of coronary heart disease.
“It found that 48% of physicians were inconsistent in their population-level and individual level assessments and that the physicians’ gender-based population prevalence assessments were not associated with the certainty of their diagnosis of coronary heart disease.”
From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [36]
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- Authors
- Maserejian, N. N., Lutfey, K. E., & McKinlay, J. B.
- Affiliations
- New England Research Institutes (US)
- Corresponding author
- Maserejian, Nancy N.
- Venue
- Health Services Research
- Publisher
- Wiley
- Published
- 2009-11-13
- Volume
- 44
- Issue
- 6
- Pages
- 1933-1949
- ISSN
- 0017-9124 (ISSN-L)
- 1475-6773
- PMC
- PMC2796307
- OpenAlex
- W2054513656
- Cited by
- 21
- References
- 2
- Citations by year
- 2026: 1 · 2019: 1 · 2018: 1 · 2017: 3 · 2016: 2 · 2015: 1 · 2013: 3 · 2012: 5
- FWCI
- 2.19
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Health Services Research (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL079174)
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
- Social Sciences › Gender Studies › Diversity and Career in Medicine
- Keywords
- coronary artery disease, diagnostic decision-making, base rates, statistical discrimination, gender differences, diagnostic certainty, prevalence data, primary care physicians, sex differences in diagnosis
- MeSH terms
- Aged, Attitude of Health Personnel, Coronary Disease, Decision Making, Female, Humans, Interviews as Topic, Male, Middle Aged, Practice Patterns, Physicians', Prejudice, Sex Factors, United States, Videotape Recording
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