April 12, 2000

BIRMINGHAM, AL — Blacks are much less likely to receive potential life-saving therapy after the onset of chest pain, according to a study from UAB's (University of Alabama at Birmingham) Center for Outcomes and Effectiveness Research and Education that appears in this week's issue of the New England Journal of Medicine.

The federally-funded study reviewed hospital records of more than 200,000 Medicare patients diagnosed with acute heart attacks at 6,684 hospitals across the country. Lead author Dr. John Canto examined the medical records of a random sample of 26,575 heart attack patients who met strict eligibility requirements to receive drug therapy or coronary angioplasty to unblock clogged arteries.

Canto found that white men received therapy with the highest frequency, followed by white women, black men and black women. After adjustments were made for clinical differences such as age, prevalence of other diseases and smoking habits, gender differences became minimal but the racial differences remained significant.

"Our findings emphasize the need to continue searching for explanations of racial differences in the treatment of ischemic heart disease," Canto said. "Understanding these differences will provide the key to reducing racial disparities."

Canto's study suggests several possible reasons for the differences. "There seems to be a lot of ambiguity when it comes to African-Americans and myocardial infarction, although the reasons are not readily apparent from examining medical records," Canto said. "The diagnosis is less clear for various reasons, including slight differences in diagnostic testing and differences in symptoms. Apparently, blacks may have some clinical characteristics that differ from those of whites, thus making diagnosis and decision to treat with drug therapy more difficult for doctors.

"However, it is not about overt discrimination," Canto said. "It's not a case of doctors saying 'I'm not going to treat you because you're black.' It's more about physicians not recognizing symptoms because the patients are presenting differently."

Canto's study is the second within the last month to be published in the New England Journal of Medicine by a UAB researcher. The March 22 issue of NEJM included a study by cardiologist Dr. Gerald M. Pohost concerning early detection of heart disease in women.