Race, Sex, and Physicians' Referrals for Cardiac Catheterization

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Abstract
We were surprised by the conclusion of Schulman et al. (Feb. 25 issue)1 that “the race and sex of a patient independently influence how physicians manage chest pain.” In fact, their data do not support this statement. The results of the multivariable logistic-regression analysis presented in Table 5 of their article clearly show that with the use of white men as the reference group, only black women were significantly less likely to be referred for cardiac catheterization. In fact, the odds ratio for catheterization was 1.0 for both black men (P=0.99) and white women (P>0.99), as compared with white men, suggesting an equivalence rather than a difference in the rates of referral for cardiac catheterization for these groups. It therefore seems probable that the significant differences in referral patterns with race and sex used as separate factors are dependent solely on the striking results for black women.