Hispanic patients hospitalized with acute cerebrovascular disease are more likely than non-Hispanic whites hospitalized with the same problem to receive noninvasive diagnostic tests and are less likely to receive invasive diagnostic and therapeutic procedures. However, when hospital experience with Hispanic patients is taken into account, ethnic disparities in procedure use are reduced or eliminated. These are the findings of a recent study by researchers at the Agency for Healthcare Research and Quality.
Hospitals that have more experience with Hispanic patients (greater proportion of Hispanic patients) may be more likely to employ bilingual and/or bicultural staff or interpreters to better understand and communicate with Hispanic patients. Physicians who are unable to communicate effectively with Hispanic patients because of either language or cultural barriers may rely on noninvasive diagnostic tests to compensate for lack of a patient history, according to AHRQ researchers Anne Elixhauser, Ph.D., Robin M. Weinick, Ph.D., and Roxanne M. Andrews, Ph.D.
Along with their colleague, Joseph R. Betancourt, M.D., M.P.H., of Massachusetts General Hospital, the researchers used 1996 hospital administrative data from New York and California—two States that account for more than 44 percent of the U.S. Hispanic population—to compare use of six diagnostic and therapeutic procedures for cerebrovascular disease for white and Hispanic patients. Hispanic patients in both California and New York were about twice as likely as white patients to undergo noninvasive diagnostic procedures (head CT scan, head/neck diagnostic ultrasound, echocardiogram, and head MRI). However, Hispanics in New York and California were 34 percent and 38 percent less likely, respectively, to receive a cerebral arteriogram and 61 and 64 percent less likely, respectively, to undergo carotid endarterectomy (surgical removal of plaque from the carotid artery in the neck) than similar white patients.
Adjusting for patient and hospital characteristics did not change these findings. However, when hospital experience with Hispanic patients was taken into account, the differences between Hispanics and non-Hispanic whites in use of noninvasive diagnostic tests were eliminated or greatly reduced.
See "Differences between Hispanics and non-Hispanic whites in use of hospital procedures for cerebrovascular disease," by Drs. Elixhauser, Weinick, Betancourt, and Andrews, in the winter 2002 Ethnicity & Disease 12, pp. 29-37.
Reprints (AHRQ Publication No. 02-R058) are available from the AHRQ Publications Clearinghouse and AHRQ InstantFax.