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African-American and Hispanic heart attack patients wait 10% to 20% longer to get emergency treatment to restore blood flow to their hearts than their Caucasian counterparts, according to a study by Yale University researchers in the October 6 issue of the Journal of the American Medical Association (JAMA).

According to the study’s authors, it doesn’t seem this disparity in care is the result of individual caregivers giving differential treatment. Rather, the disparities might be largely due to differences among the hospitals to which patients are admitted.

In a study of about 110,000 myocardial infarction patients treated in more than 1,000 hospitals nationwide, researchers estimated racial and ethnic differences in emergency treatment for heart attacks, looking at door-to-drug times for fibrinolytic therapy and door-to-balloon times for percutaneous coronary intervention. They then examined the roles of sociodemographic factors, insurance status, clinical characteristics, and health system factors on the treatment provided. Elizabeth H. Bradley, PhD, and her colleagues report door-to-drug times were 41.1 minutes for African-American patients, 36.1 minutes for Hispanics, and 37.4 minutes for Asian/Pacific Islanders, compared with 33.8 minutes for patients identified as white.

The study’s authors report door-to-balloon times were 122.3 minutes for African-American patients, 114.8 minutes for Hispanics, and 103.4 minutes for whites.

According to the authors, “crude difference in door-to-balloon time between African-American and Caucasian patients was reduced by 33% after accounting for differences between the hospitals in which patients were treated. More striking, the crude difference in door-to-balloon times between Hispanic patients and white patients was reduced by nearly 75% after accounting for differences between the hospitals in which they were treated.”

“The findings suggest we may have dual systems of care, in which many minority patients are less likely to receive treatment in the higher-quality hospitals. Eliminating disparities might best be achieved by efforts to improve quality at poorer performing hospitals and ensure all patients have access to high-quality hospitals,” said Harlan M. Krumholz, MD, professor of medicine at Yale and senior author of the study, in a Yale University media release.

Interventions to eliminate racial disparities will probably fall short unless accompanied by systemic changes that ensure all patients have access to high-quality hospitals, according to the study.

Margaret A. Winker, MD, JAMA’s deputy editor and the author of an editorial on the study, says there has been the assumption that physicians and other health care professionals are treating patients differently by virtue of race.

“This study doesn’t rule out that that’s the case, necessarily,” says Winker, “but it does indicate that looking at that as the entire reason is just way too simplistic.”

The issue goes back to the basic question of whether disparities in health care are racial or socioeconomic problems, says Carol Ferrans, RN, PhD, FAAN, professor at the University of Illinois at Chicago College of Nursing and deputy director for the Disparities Center at the University of Illinois.

“This is something that cuts across our health care system in the U.S.,” Ferrans says. “That many of our racial minorities find themselves in the lower socioeconomic strata and get health care at institutions that are financially disadvantaged may be the reason we’re seeing what we’re seeing in JAMA. At least it flags this issue as a systemic problem in America, which I think is important and needs to be addressed.”

Ferrans reported similar findings in her research looking at minority access to mammography. She found minority women in Chicago do not have easy access to mammography units. As a result, African Americans and Latinos in the city have harder times getting mammograms than whites.

“I can tell you that in the financially disadvantaged areas the density of mammography screening facilities is much less than in, for example, DuPage County,” she says. “In DuPage County you have hospitals competing heavily [for the business],” she says. “The root problem is the way health care is financed in this country. The way it is financed right now is completely on the ability to pay.”

Lisette Hilton is a freelance writer.