Raczynski J M, Taylor H, Cutter G, Hardin M, Rappaport N, Oberman A
School of Medicine, University of Alabama at Birmingham.
Am J Public Health. 1994 Jun;84(6):951-6. doi: 10.2105/ajph.84.6.951.
This study examined health care-seeking behaviors to elucidate factors that contribute to differences in patterns of coronary heart disease between African Americans and Whites. The prevalence of diagnosed coronary heart disease, patients' perceptions of symptoms and attribution of symptoms, and predictors of painful symptoms and attribution of cardiac symptoms were examined.
The study involved 2416 patients admitted with diagnoses of coronary artery disease, ischemic heart disease, or myocardial infarction or to rule out myocardial infarction. Structured interview questions were used to obtain demographic information, symptoms precipitating admission, and patients' attribution of their symptoms. Discharge diagnoses were obtained from hospital records.
Acute myocardial infarction, unstable angina, nonacute ischemic heart disease, and atherosclerosis were more frequent in White patients. For Blacks, the odds of reporting painful symptoms were only 64% of the odds found for Whites when other factors were controlled, and the odds of attributing symptoms to cardiac origins were almost 50% lower for Blacks than for Whites.
The tendency of Blacks to report fewer painful symptoms and to attribute their symptoms to noncardiac origins may contribute to differences in care-seeking and in medical management of heart disease in Blacks.
本研究调查了寻求医疗行为，以阐明导致非裔美国人和白人冠心病模式差异的因素。研究了确诊冠心病的患病率、患者对症状的认知和症状归因，以及疼痛症状和心脏症状归因的预测因素。
该研究纳入了2416例诊断为冠状动脉疾病、缺血性心脏病或心肌梗死或排除心肌梗死的患者。采用结构化访谈问题获取人口统计学信息、促使入院的症状以及患者对其症状的归因。出院诊断来自医院记录。
白人患者中急性心肌梗死、不稳定型心绞痛、非急性缺血性心脏病和动脉粥样硬化更为常见。对于黑人，在控制其他因素后，报告疼痛症状的几率仅为白人的64%，黑人将症状归因于心脏起源的几率比白人低近50%。
黑人报告较少疼痛症状并将其症状归因于非心脏起源的倾向可能导致黑人在寻求医疗和心脏病医疗管理方面的差异。
