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Comparison of the Diagnostic Process in Blacks and Whites

Paul D. Stein, MD; Russell D. Hull, MBBS, MSc; Kalpesh C. Patel, MBBS; Ronald E. Olson, PhD; William A. Ghali, MD, MPH; Andrew K. Alshab, MD, MPH; Frederick A. Meyers, MD

Arch Intern Med. 2003;163:1843-1848.

Background  There has been concern that a disproportionate use of some health services exists among races. Whether this applies to patients with pulmonary embolism (PE) or deep venous thrombosis (DVT) has not been determined.

Objective  To assess if there is a racial disparity in the application of diagnostic tests for PE or DVT, or in reaching a diagnosis or using medical facilities.

Design  A study of cross-sectional samples of hospitalizations during 21 years using data from the National Hospital Discharge Survey.

Setting  Noninstitutional hospitals in 50 states and the District of Columbia from January 1, 1979, through December 31, 1999.

Patients  The National Hospital Discharge Survey abstracts demographic and medical information from the medical records of inpatients. For 1979 through 1999, the number of patients sampled ranged annually from 181 000 to 307 000.

Measurements  The number of sampled patients with DVT and with PE and the number of diagnostic tests performed were determined from the International Classification of Diseases, Ninth Revision, Clinical Modification codes at discharge. A multistage estimation procedure gave an estimate of values for the entire United States.

Results  The age-adjusted rates of diagnosis of PE and of DVT per 100 000 population were not lower in blacks than in whites. Rates of use of radioisotopic lung scans, venous ultrasonography of the lower extremities, and contrast venography were comparable between races. The durations of hospitalization for patients with a primary discharge diagnosis of PE and of DVT were also comparable.

Conclusions  There is nothing to suggest that diagnostic tests are being withheld, and there is no evidence of a failure to reach a diagnosis in blacks with thromboembolic disease.

From the Research Department, St Joseph Mercy Oakland Hospital, Pontiac (Drs Stein, Patel, and Alshab), and Department of Health Sciences, Oakland University, Rochester (Dr Olson), Mich; Department of Medicine, University of Calgary, Alberta (Mr Hull and Dr Ghali); and Department of Medicine, George Washington University, Washington, DC (Dr Meyers). The authors have no relevant financial interest in this article.

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