A Retrospective Assessment Of The Association Between Patient Factors And African Americans' Willingness
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Type of WorkText
DepartmentPublic Health and Policy
ProgramDoctor of Public Health
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For over 100 years, cardiovascular disease (CVD) has been the leading cause of death in the United States. African Americans are a high-risk CVD subpopulation. Heart catheterization is a valuable gateway invasive diagnostic cardiac procedure used to detect and treat CVD. However, CVD-related racial and ethnic disparities exist in accessing and utilizing heart catheterizations. When compared to Whites, African Americans are the least willing to undergo the heart catheterization procedures and, the least likely to receive access to them. Since intra-racial cardiac research regarding African Americans' willingness decisions is limited, the objective of this study was to assess patient factors associated with African American patients' willingness to accept the heart catheterization procedure. Clinical and administrative data from the Cardiac ACCESS Longitudinal (CAL) Study were used for this study. The CAL Study is an active interracial (N=1669,  Black and  White cardiac patients) retrospective, cross-sectional study that was conducted in three urban hospitals in Baltimore City. This secondary analysis sample consisted of 298 African American cardiac patients' records. An integrated theoretical model consisting of the social conflict theory and psychological conflict theory of decision-making was used in the study. Societal (macro-level) and individual (micro-level) patient factors were assessed to examine the patients' willingness to accept the heart catheterization procedure. Frequency distributions, chi square and logistic regression analyses were used to examine patient factors associated with the patients' willingness to accept the heart catheterization procedure. While a majority of the cardiac patients (78.2%) were willing to accept the heart catheterization procedure, over half (50.5%) of the cardiac patients had high-perceived racism, 53.5% had high medical mistrust and, 59.5% were satisfied with their hospital and physician interactions. However, after controlling for onsite catheterization laboratory and receipt of the heart catheterization, a single medical mistrust statement and being older were associated with lower odds of being willing to accept the heart catheterization procedure. Patients who agreed hospitals experiment on people without their knowledge were 63% less willing to accept the cardiac procedure than those who disagreed with the statement (p= .010; OR = .37; CI: .177 -.794). Patients 50-64 years old were 73% less willing to accept the heart catheterization than patients >80 years old (p=.038; OR=.27; CI: .083- .931). Since African Americans are adversely impacted by CVD, the study findings offer insight into patient factors associated with their willingness to accept heart catheterizations. Further study is recommended to examine the impact the future study findings would have on African American cardiac patients' utilization of heart catheterization.