Despite the increasing literature suggesting racial disparities in invasive cardiac care, few studies have examined differences in cardiac noninvasive care. Allison et al. used discharge data from all acute care hospitals in Alabama from June 1992 through February 1993 to examine the differences in the use of thrombolysis, beta-adrenergic blockade and aspirin among patients diagnosed with Acute Myocardial Infarction (AMI). The population was restricted to African American and Caucasian Medicare beneficiaries over 65 years of age. Race was the primary independent variable and other covariates, including determined candidacy for therapy (ideal patient status), age, gender, hospital variables (rural vs. urban, teaching vs. nonteaching, number of AMIs treated), and severity of illness, were entered separately into a multivariate model.

The crude analysis of the data did not show a statistically significant difference in the therapeutic use of beta-adrenergic blockade and aspirin. However, a significant difference was found for the use of thrombolysis – 9.2% of African-Americans received thrombolysis versus 17.3% of Caucasians. When ideal candidacy by algorithm was factored in, 50% of black patients deemed to be ideal candidates received thrombolysis compared to 68% of white patients. The analysis including all other covariates yielded an adjusted odds ratio of .55 (95% CI: 0.41-0.77) for blacks versus whites receiving thrombolysis. No difference was found in the use of aspirin and beta-blockers.

The authors conclude that “this inequality persisted even after adjustment for severity of illness and comorbidity.” It “appears that African Americans received less thrombolysis both when they were ideal candidates and when they were not ideal candidates,” and “the overall racial disparity was not due to administration of thrombolytic agents to Caucasians for ‘softer’ indications (overuse).” Additionally, “the analysis did not find hospital characteristics to be significant predictors.” The investigators conclude that their “analysis suggests (but does not prove) that this resulted from inappropriately withholding treatment from African Americans.”

The authors also note, “Some propose that cultural experience produces distrust of the medical system leading to a high rate of refusal of technological interventions…our data suggest that this is not the case because the same percentage of African Americans and Caucasians refused treatment."