Blacks Often Receive Less Cardiac Care

A new study by researchers at UC San Francisco has concluded that African-American patients  in many parts of California are more likely than whites to have their ambulance diverted to another hospital due to nearby emergency room crowding.

The greater chance of being diverted meant that African-Americans with heart conditions are less likely to receive specialized cardiac care and have lower short-term survival rates.

The study, which appeared in the online version of the British Medical Journal, examined ambulance diversion logs in 26 California counties and connected them to patients suffering from several heart attacks. The sample included nearly 30,000 heart attack patients. About half experienced some sort of diversion during their ambulance rides, and a quarter had diversions lasting six hours or more. 

A significant number of the diverted patients were African-Americans. The study found they are more likely to live in communities served by hospitals that have overcrowded emergency rooms, thereby requiring a diversion.

Patients experiencing the longest diversions were 4.3% less likely to receive cardiac catheterization, the most common method of treating a heart attack. 

Those patients also had a one-year mortality rate nearly 10% higher than those in ambulances that had not been diverted, the study concluded.

“The take-home findings from this study are two-fold,” said Renee Hsia, M.D., professor of emergency medicine and health policy at UCSF. “First, we now better understand the mechanisms behind emergency department crowding and how it affects patients. Not only are crowded hospitals less able to deliver high-quality care, but even sick patients get diverted to hospitals with less technology. On top of that, they are less likely to receive appropriate treatment.”

The study is one of many in recent years chronicling care disparities among African-American and other minority communities. It did not make any specific recommendations.

“Our hope is that we can take this evidence and translate it into change at the systems level,” Hsia said. “While focusing efforts to decrease emergency department crowding is necessary in all hospitals, it might be more ‘bang for the buck’ if we want to make a dent in decreasing disparities by targeting efforts in minority-serving hospitals.”