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Nancy R. Kressin, PhD, Bei-Hung Chang, ScD, Jeff Whittle, MD, MPH, Eric D. Peterson, MD, MPH, Jack A. Clark, PhD, Amy K. Rosen, PhD, Michelle Orner, MPH, Tracie C. Collins, MD, MPH, Linda G. Alley, PhD, RN and Laura A. Petersen, MD, MPH

Nancy R. Kressin, Bei-Hung Chang, Jack A. Clark, Amy K. Rosen, and Michelle Orner are with the Center for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Medical Center, Bedford, Mass. Nancy R. Kressin, Bei-Hung Chang, Jack A. Clark, and Amy K. Rosen are also with the Health Services Department, Boston University School of Public Health, Boston, Mass. Jeff Whittle is with the Division of General and Geriatric Medicine, Kansas University Medical Center, Kansas City, Kan, and the Kansas City Veterans Affairs Medical Center, Kansas City, Mo. Eric D. Peterson is with the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Tracie C. Collins and Laura A. Petersen are with the Houston Center for Quality of Care and Utilization Studies, Houston Veterans Affairs Medical Center, Houston, Tex, and the Division of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston. Linda G. Alley is with the Rehabilitation R&D Center, Atlanta Veterans Affairs Medical Center, Atlanta, Ga, and the Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta.

Correspondence: Requests for reprints should be sent to Nancy R. Kressin, PhD, Center for Health Quality, Outcomes and Economic Research, VA Medical Center, 200 Springs Rd, Building 70 (152), Bedford, MA 01730 (e-mail: nkressin{at}bu.edu).

Objectives. We examined racial differences in cardiac catheterization rates and reviewed whether patients’ beliefs or other variables were associated with observed disparities.

Methods. We did a prospective observational cohort study of 1045 White and African American patients at 5 Veterans Affairs (VA) medical centers whose nuclear imaging studies indicated reversible cardiac ischemia.

Results. There were few demographic differences between White and African American patients in our sample. African Americans were less likely than Whites to undergo cardiac catheterization. African Americans were more likely than Whites to indicate a strong reliance on religion and to report racial and social class discrimination and were less likely to indicate a generalized trust in people but did not differ from White patients on numerous other attitudes about health and health care. Neither sociodemographic or clinical characteristics nor patients’ beliefs explained the observed disparities, but physicians’ assessments of the procedure’s importance and patients’ likelihood of coronary disease seemed to account for differences not otherwise explained.

Conclusions. Patients’ preferences are not the likely source of racial disparities in the use of cardiac catheterization among veterans using VA care, but physicians’ assessments warrant further attention.

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