Skip to main content
NCBI home page
American Journal of Public Health logoLink to American Journal of Public Health
. 1994 Jun;84(6):957–964. doi: 10.2105/ajph.84.6.957

Do blacks and whites differ in their use of health care for symptoms of coronary heart disease?

S L Crawford 1, S A McGraw 1, K W Smith 1, J B McKinlay 1, J E Pierson 1
PMCID: PMC1614940  PMID: 8203693

Abstract

OBJECTIVES. The purpose of this study was to identify the role of race in seeking and receipt of care for symptoms of coronary heart disease. METHODS. Data on medical care, sociodemographic characteristics, symptoms, risk factors, income, and insurance were collected in a telephone interview for a random sample of 2030 Black and White adults in inner-city Boston. Rates of care-seeking for symptoms, amounts of delay in seeking care, and rates of receipt of care were compared for Blacks and Whites after adjustment for other characteristics. RESULTS. Before and after adjustment for other factors, Blacks and Whites were equally likely to seek care. Average delay time was shorter for Blacks, particularly Black women. With the exception of a lower rate of referral to cardiologists among Blacks, receipt of care was similar for Blacks and Whites who sought medical attention for symptoms. CONCLUSIONS. In an urban population of Blacks and Whites who were similar in socioeconomic status and access to medical care, there were few racial differences in coronary heart disease-related care patterns.

Full text

PDF
957

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aday L. A., Andersen R. M. The national profile of access to medical care: where do we stand? Am J Public Health. 1984 Dec;74(12):1331–1339. doi: 10.2105/ajph.74.12.1331. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Ayanian J. Z., Epstein A. M. Differences in the use of procedures between women and men hospitalized for coronary heart disease. N Engl J Med. 1991 Jul 25;325(4):221–225. doi: 10.1056/NEJM199107253250401. [DOI] [PubMed] [Google Scholar]
  3. Bombardier C., Fuchs V. R., Lillard L. A., Warner K. E. Socioeconomic factors affecting the utilization of surgical operations. N Engl J Med. 1977 Sep 29;297(13):699–705. doi: 10.1056/NEJM197709292971305. [DOI] [PubMed] [Google Scholar]
  4. Bush T. L., Miller S. R., Golden A. L., Hale W. E. Self-report and medical record report agreement of selected medical conditions in the elderly. Am J Public Health. 1989 Nov;79(11):1554–1556. doi: 10.2105/ajph.79.11.1554. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Centers for Disease Control (CDC) Black/white comparisons of premature mortality for public health program planning--District of Columbia. MMWR Morb Mortal Wkly Rep. 1989 Jan 27;38(3):33–37. [PubMed] [Google Scholar]
  6. Cooper R. S., Simmons B., Castaner A., Prasad R., Franklin C., Ferlinz J. Survival rates and prehospital delay during myocardial infarction among black persons. Am J Cardiol. 1986 Feb 1;57(4):208–211. doi: 10.1016/0002-9149(86)90892-1. [DOI] [PubMed] [Google Scholar]
  7. Davis K., Gold M., Makuc D. Access to health care for the poor: does the gap remain? Annu Rev Public Health. 1981;2:159–182. doi: 10.1146/annurev.pu.02.050181.001111. [DOI] [PubMed] [Google Scholar]
  8. Feinleib M., Davidson M. J. Coronary heart disease mortality. A community perspective. JAMA. 1972 Nov 27;222(9):1129–1134. [PubMed] [Google Scholar]
  9. Fienberg S. E., Loftus E. F., Tanur J. M. Recalling pain and other symptoms. Milbank Mem Fund Q Health Soc. 1985 Summer;63(3):582–597. [PubMed] [Google Scholar]
  10. Ford E., Cooper R., Castaner A., Simmons B., Mar M. Coronary arteriography and coronary bypass survey among whites and other racial groups relative to hospital-based incidence rates for coronary artery disease: findings from NHDS. Am J Public Health. 1989 Apr;79(4):437–440. doi: 10.2105/ajph.79.4.437. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Gillum R. F. Coronary artery bypass surgery and coronary angiography in the United States, 1979-1983. Am Heart J. 1987 May;113(5):1255–1260. doi: 10.1016/0002-8703(87)90952-5. [DOI] [PubMed] [Google Scholar]
  12. Gillum R. F. Coronary heart disease in black populations. I. Mortality and morbidity. Am Heart J. 1982 Oct;104(4 Pt 1):839–851. doi: 10.1016/0002-8703(82)90021-7. [DOI] [PubMed] [Google Scholar]
  13. Glueck C. J., Gartside P., Laskarzewski P. M., Khoury P., Tyroler H. A. High-density lipoprotein cholesterol in blacks and whites: potential ramifications for coronary heart disease. Am Heart J. 1984 Sep;108(3 Pt 2):815–826. doi: 10.1016/0002-8703(84)90677-x. [DOI] [PubMed] [Google Scholar]
  14. Haywood L. J. Coronary heart disease mortality/morbidity and risk in blacks. I: Clinical manifestations and diagnostic criteria: the experience with the Beta Blocker Heart Attack Trial. Am Heart J. 1984 Sep;108(3 Pt 2):787–793. doi: 10.1016/0002-8703(84)90672-0. [DOI] [PubMed] [Google Scholar]
  15. Hosmer D. W., Taber S., Lemeshow S. The importance of assessing the fit of logistic regression models: a case study. Am J Public Health. 1991 Dec;81(12):1630–1635. doi: 10.2105/ajph.81.12.1630. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. James S. A., Wagner E. H., Strogatz D. S., Beresford S. A., Kleinbaum D. G., Williams C. A., Cutchin L. M., Ibrahim M. A. The Edgecombe County (NC) High Blood Pressure Control Program: II. Barriers to the use of medical care among hypertensives. Am J Public Health. 1984 May;74(5):468–472. doi: 10.2105/ajph.74.5.468. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Keil J. E., Loadholt C. B., Weinrich M. C., Sandifer S. H., Boyle E., Jr Incidence of coronary heart disease in blacks in Charleston, South Carolina. Am Heart J. 1984 Sep;108(3 Pt 2):779–786. doi: 10.1016/0002-8703(84)90671-9. [DOI] [PubMed] [Google Scholar]
  18. Keil J. E., Saunders D. E., Jr, Lackland D. T., Weinrich M. C., Hudson M. B., Gastright J. A., Baroody N. B., O'Bryan E. C., Jr, Zmyslinski R. W. Acute myocardial infarction: period prevalence, case fatality, and comparison of black and white cases in urban and rural areas of South Carolina. Am Heart J. 1985 Apr;109(4):776–784. doi: 10.1016/0002-8703(85)90638-6. [DOI] [PubMed] [Google Scholar]
  19. Lee M. H., Borhani N. O., Kuller L. H. Validation of reported myocardial infarction mortality in blacks and whites. A report from the Community Cardiovascular Surveillance Program. Ann Epidemiol. 1990 Oct;1(1):1–12. doi: 10.1016/1047-2797(90)90014-j. [DOI] [PubMed] [Google Scholar]
  20. MANTEL N., HAENSZEL W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959 Apr;22(4):719–748. [PubMed] [Google Scholar]
  21. Maynard C., Fisher L. D., Passamani E. R., Pullum T. Blacks in the Coronary Artery Surgery Study: risk factors and coronary artery disease. Circulation. 1986 Jul;74(1):64–71. doi: 10.1161/01.cir.74.1.64. [DOI] [PubMed] [Google Scholar]
  22. Maynard C., Fisher L. D., Passamani E. R., Pullum T. Blacks in the coronary artery surgery study (CASS): race and clinical decision making. Am J Public Health. 1986 Dec;76(12):1446–1448. doi: 10.2105/ajph.76.12.1446. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Maynard C., Fisher L. D., Passamani E. R. Survival of black persons compared with white persons in the Coronary Artery Surgery Study (CASS). Am J Cardiol. 1987 Sep 1;60(7):513–518. doi: 10.1016/0002-9149(87)90296-7. [DOI] [PubMed] [Google Scholar]
  24. McCord C., Freeman H. P. Excess mortality in Harlem. N Engl J Med. 1990 Jan 18;322(3):173–177. doi: 10.1056/NEJM199001183220306. [DOI] [PubMed] [Google Scholar]
  25. Mutchler J. E., Burr J. A. Racial differences in health and health care service utilization in later life: the effect of socioeconomic status. J Health Soc Behav. 1991 Dec;32(4):342–356. [PubMed] [Google Scholar]
  26. O'Toole B. I., Battistutta D., Long A., Crouch K. A comparison of costs and data quality of three health survey methods: mail, telephone and personal home interview. Am J Epidemiol. 1986 Aug;124(2):317–328. doi: 10.1093/oxfordjournals.aje.a114390. [DOI] [PubMed] [Google Scholar]
  27. Oberman A., Cutter G. Issues in the natural history and treatment of coronary heart disease in black populations: surgical treatment. Am Heart J. 1984 Sep;108(3 Pt 2):688–694. doi: 10.1016/0002-8703(84)90656-2. [DOI] [PubMed] [Google Scholar]
  28. Penchansky R., Fox D. Frequency of referral and patient characteristics in group practice. Med Care. 1970 Sep-Oct;8(5):368–385. doi: 10.1097/00005650-197009000-00004. [DOI] [PubMed] [Google Scholar]
  29. Penchansky R., Thomas J. W. The concept of access: definition and relationship to consumer satisfaction. Med Care. 1981 Feb;19(2):127–140. doi: 10.1097/00005650-198102000-00001. [DOI] [PubMed] [Google Scholar]
  30. Sempos C., Cooper R., Kovar M. G., McMillen M. Divergence of the recent trends in coronary mortality for the four major race-sex groups in the United States. Am J Public Health. 1988 Nov;78(11):1422–1427. doi: 10.2105/ajph.78.11.1422. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Simmons B. E., Castaner A., Mar M., Islam N., Cooper R. Survival determinants in black patients with angiographically defined coronary artery disease. Am Heart J. 1990 Mar;119(3 Pt 1):513–519. doi: 10.1016/s0002-8703(05)80272-8. [DOI] [PubMed] [Google Scholar]
  32. Steingart R. M., Packer M., Hamm P., Coglianese M. E., Gersh B., Geltman E. M., Sollano J., Katz S., Moyé L., Basta L. L. Sex differences in the management of coronary artery disease. Survival and Ventricular Enlargement Investigators. N Engl J Med. 1991 Jul 25;325(4):226–230. doi: 10.1056/NEJM199107253250402. [DOI] [PubMed] [Google Scholar]
  33. Strogatz D. S. Use of medical care for chest pain: differences between blacks and whites. Am J Public Health. 1990 Mar;80(3):290–294. doi: 10.2105/ajph.80.3.290. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Tofler G. H., Stone P. H., Muller J. E., Willich S. N., Davis V. G., Poole W. K., Strauss H. W., Willerson J. T., Jaffe A. S., Robertson T. Effects of gender and race on prognosis after myocardial infarction: adverse prognosis for women, particularly black women. J Am Coll Cardiol. 1987 Mar;9(3):473–482. doi: 10.1016/s0735-1097(87)80038-4. [DOI] [PubMed] [Google Scholar]
  35. Weeks M. F., Kulka R. A., Lessler J. T., Whitmore R. W. Personal versus telephone surveys for collecting household health data at the local level. Am J Public Health. 1983 Dec;73(12):1389–1394. doi: 10.2105/ajph.73.12.1389. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Weissman J. S., Stern R., Fielding S. L., Epstein A. M. Delayed access to health care: risk factors, reasons, and consequences. Ann Intern Med. 1991 Feb 15;114(4):325–331. doi: 10.7326/0003-4819-114-4-325. [DOI] [PubMed] [Google Scholar]
  37. Wenneker M. B., Epstein A. M. Racial inequalities in the use of procedures for patients with ischemic heart disease in Massachusetts. JAMA. 1989 Jan 13;261(2):253–257. [PubMed] [Google Scholar]
  38. Wenneker M. B., Weissman J. S., Epstein A. M. The association of payer with utilization of cardiac procedures in Massachusetts. JAMA. 1990 Sep 12;264(10):1255–1260. [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES