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Medical Care Research and Review
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Explaining Racial Differences in Receipt of Coronary Angiography: The Role of Physician Referral and Physician Specialty

Thomas A. LaVeist

Johns Hopkins University

Melanie Arthur

Portland State University

Athol Morgan

One Heart, LLC

Stephen Plantholt

St. Agnes Healthcare

Michael Rubinstein

Bon Secour Baltimore Health System

The authors examine three hypotheses regarding race differences in utilization of coronary angiography (CA): (1) patients with a cardiology consultation are more likely to obtain a referral for CA, (2) African American patients are less likely to have a cardiology consultation, and (3) among patients referred for CA, there is no difference by race in receipt of the procedure. To determine if they obtained a referral for or received CA, 2,623 candidates for CA were followed. Multivariate models were estimated using logistic regression. Cardiology consultation was associated with referral for CA (OR = 5.1,p < .001). White patients had higher odds of cardiology consultation (OR = 2.2,p < .001). The racial disparity was reduced among patients who received a referral (OR = 1.4,p < .05). Researchers must eliminate racial differences in access to specialty care and variation in referral patterns by physician specialty, and efforts must be targeted to those specialties where greater disparities exist.

Key Words: race disparities • coronary angiography • referral patterns • physician behavior • race • black • African American • minority health

Medical Care Research and Review, Vol. 60, No. 4, 453-467 (2003)
DOI: 10.1177/1077558703255685
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