Young Adult Women and People of Color With Chest Pain Wait Longer at the Emergency Department

A study found that among young adults, women and people of color waited longer at the emergency department (ED) to be seen by physicians for chest pain. These findings were published in the Journal of the American Heart Association.

Investigators at the New York University Grossman School of Medicine sourced data for this study from the Centers for Disease Control and Prevention’s National Hospital Ambulatory Medical Care Survey (NHAMCS)-ED collected between 2014 and 2018. Patients (n=29,730,145) aged 18 to 55 years who sought medical care at the ED for chest pain were evaluated for wait times and treatments on the basis of gender and ethnicity.

Women (n=16,880,659) and men (n=12,849,486) were aged mean 37.6±10.6 and 38.8±10.7 years (P =.016); 37.3% and 31.6% were persons of color (P =.026); 82.5% and 78.7% did not arrive by ambulance; and 86.6% and 89.0% were first-time ED visitors for chest pain, respectively.

Women presenting with chest pain were more likely to have asthma, chronic obstructive pulmonary disease, depression, and obesity (all P £.044) and less likely to present with hypertension or substance abuse (both P £.004) compared with men.

Women were less likely to be seen immediately (P =.011), to be seen by a consulting physician (P =.001), to be prescribed antiplatelet agents (P =.004) or antianginal medications (P =.002), and to be diagnosed with hypertensive disease (P =.011) or coronary atherosclerosis and other heart disease (P =.044). In the multivariate model, men were more likely to be seen at any given time (adjusted hazard ratio [aHR], 1.15; 95% CI, 1.05-1.26; P =.004) and women were less likely to be admitted to the hospital for observation (adjusted odds ratio [aOR], 1.40; 95% CI, 1.08-1.81; P =.011).

Stratified by gender and ethnicity, women of color were more likely to have hypertension and obesity than White women (both P £.014) and men of color were less likely to have hyperlipidemia or depression than White men (both P £.003).

Women and men of color waited longer than White women and men (both P =.006); women of color were less likely to receive antiplatelet agents (P <.001), narcotic analgesics (P =.002), or benzodiazepines (P =.019); and men of color were less likely to receive antianginal medications (P <.001) or narcotics (P =.013), but more likely to receive non-steroidal anti-inflammatory drugs (P =.038). In the multivariate assessment, people of color were less likely to be seen by a provider at any time (aHR, 0.82; 95% CI, 0.73-0.93; P =.001).

Although differences were observed in the raw data, no differences on the basis of gender or ethnicity were observed for receiving electrocardiography, cardiac enzyme testing, or emergent triage after multivariate adjustment.

This study may have been limited by only evaluating chest pain even though some patients with acute myocardial infarction can present with other symptoms.

The study authors concluded that these data indicated that women and people of color who presented at the ED with chest pain waited longer to be evaluated by a physician and were less likely to be given medications for acute myocardial infarction.

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Banco D, Chang J, Talmor N, et al. Sex and race differences in the evaluation and treatment of young adults presenting to the emergency department with chest pain. J Am Heart Assoc. Published online May 4, 2022. doi:10.1161/JAHA.121.024199