Table 2.
Prevalence and Adjusted Odds of Cardiac Stress Test Order or Performance in U.S. Ambulatory Care Visits, 1993–2010
| All Ambulatory Visits | Office-based Visits Only | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Unweighted No. |
Test Rate per 10,000† |
Adjusted OR | 95% CI | P value |
Unweighted No. |
Test Rate per 10,000† |
Adjusted OR | 95% CI | P value | |
| Age, yrs | ||||||||||
| 18–44 | 582 | 19 | 1.00 | 353 | 20 | 1.00 | ||||
| 45–64 | 1,593 | 61 | 2.43 | 2.02 to 2.93 | <0.001 | 1,035 | 62 | 2.29 | 1.86 to 2.81 | <0.001 |
| 65–79 | 833 | 52 | 2.31 | 1.79 to 2.99 | <0.001 | 570 | 53 | 1.94 | 1.45 to 2.59 | <0.001 |
| >80 | 146 | 31 | 0.95 | 0.66 to 1.37 | 0.80 | 107 | 32 | 0.69 | 0.46 to 1.02 | 0.064 |
| Gender | ||||||||||
| Female | 1,592 | 31 | 0.61 | 0.54 to 0.69 | <0.001 | 1,020 | 32 | 0.60 | 0.52 to 0.68 | <0.001 |
| Male | 1,562 | 56 | 1.00 | 1,045 | 58 | 1.00 | ||||
| Ethnicity | ||||||||||
| White | 1,855 | 41 | 1.00 | 1,256 | 42 | 1.00 | ||||
| Black | 278 | 38 | 0.91 | 0.69 to 1.21 | 0.52 | 140 | 41 | 0.95 | 0.68 to 1.33 | 0.76 |
| Hispanic | 254 | 33 | 0.75 | 0.55 to 1.02 | 0.064 | 126 | 34 | 0.70 | 0.52 to 0.94 | 0.017 |
| Other/unknown | 767 | 42 | 0.97 | 0.82 to 1.15 | 0.70 | 543 | 44.0 | 0.96 | 0.80 to 1.15 | 0.63 |
| Insurance | ||||||||||
| Private | 1,626 | 47 | 1.00 | 1,186 | 48 | 1.00 | ||||
| Medicare | 876 | 43 | 0.8 | 0.65 to 0.98 | 0.036 | 606 | 44 | 0.81 | 0.64 to 1.02 | 0.07 |
| Medicaid | 228 | 22 | 0.59 | 0.41 to 0.84 | 0.004 | 65 | 24 | 0.52 | 0.33 to 0.82 | 0.005 |
| Uninsured | 161 | 15 | 0.39 | 0.28 to 0.56 | <0.001 | 49 | 14 | 0.47 | 0.31 to 0.71 | <0.001 |
| Other/unknown | 263 | 32 | 0.79 | 0.57 to 1.09 | 0.156 | 159 | 34.0 | 0.87 | 0.60 to 1.25 | 0.45 |
| Region | ||||||||||
| Northeast | 679 | 37 | 1.00 | 396 | 39 | 1.00 | ||||
| Midwest | 691 | 39 | 1.07 | 0.86 to 1.34 | 0.53 | 428 | 40 | 1.18 | 0.92 to 1.51 | 0.196 |
| South | 1,135 | 40 | 1.11 | 0.88 to 1.40 | 0.36 | 745 | 41 | 1.15 | 0.89 to 1.49 | 0.27 |
| West | 649 | 45 | 1.29 | 1.00 to 1.67 | 0.047 | 496 | 46 | 1.37 | 1.04 to 1.81 | 0.026 |
| Metropolitan statistical area | ||||||||||
| Urban | 2,857 | 41 | 1.00 | 1,869 | 43 | 1.00 | ||||
| Rural | 297 | 34 | 0.83 | 0.64 to 1.07 | 0.157 | 196 | 35 | 0.99 | 0.74 to 1.32 | 0.94 |
| Physician specialty | ||||||||||
| Primary care | - | - | 454 | 36 | 1.00 | |||||
| Cardiology | - | - | 1,494 | 901 | 14.2 | 11.3 to 17.7 | <0.001 | |||
| Other | - | - | 117 | 6 | 0.17 | 0.11 to 0.27 | <0.001 | |||
| Reason for visit | ||||||||||
| Chest pain | 1,123 | 958 | 36.3 | 31.2 to 42.25 | <0.001 | 691 | 975 | 12.2 | 9.75 to 15.24 | <0.001 |
| Other | 2,031 | 28.0 | 1.00 | 1,374 | 29.0 | 1.00 | ||||
| Smoker | ||||||||||
| Yes | 343 | 42 | 0.93 | 0.77 to 1.13 | 0.49 | 217 | 44 | 0.97 | 0.78 to 1.21 | 0.81 |
| Unknown | 1,466 | 36 | 0.94 | 0.80 to 1.12 | 0.49 | 860 | 38 | 0.99 | 0.82 to 1.2 | 0.92 |
| No | 1,345 | 45 | 1.00 | 988 | 45 | 1.00 | ||||
| Visit diagnosis¶ | ||||||||||
| Hypertension | 822 | 103 | 2.08 | 1.76 to 2.47 | <0.001 | 544 | 106 | 1.19 | 0.99 to 1.44 | 0.061 |
| Dyslipidemia | 374 | 149 | 2.50 | 1.98 to 3.15 | <0.001 | 285 | 151 | 1.69 | 1.32 to 2.17 | <0.001 |
| Diabetes | 213 | 44 | 0.69 | 0.51 to 0.92 | 0.011 | 103 | 44 | 0.76 | 0.55 to 1.05 | 0.095 |
| Obesity | 101 | 84 | 1.97 | 1.43 to 2.69 | <0.001 | 68 | 87 | 1.39 | 0.94 to 2.06 | 0.097 |
Abbreviations: CI, confidence interval; OR, odds ration; No., number; CHD, coronary heart disease
*
Includes only adults without a diagnosis of CHD. Logistic regression models adjusted for patient and provider characteristics.
†
Cardiac stress test rate among all visits of adults without a diagnosis of CHD and falling within subgroup
¶
Reference for each diagnosis category includes all visits without the diagnosis category