Minority patients with heart attack symptoms wait longer for treatment than whites do, according to a recent study led by Harlan M. Krumholz, M.D., M.Sc., professor of medicine (cardiology), and Elizabeth H. Bradley, Ph.D. ’96, associate professor of public health (health policy and administration). But waiting time appears to have more to do with the choice of hospital than any conscious decision by health care providers to discriminate based on race or ethnicity.

For the study, published in the October 6 issue of JAMA: The Journal of the American Medical Association, researchers examined data from the National Registry of Myocardial Infarction (NRMI) to determine how much time elapsed between a patient’s arrival at the hospital and the start of either drug therapy or balloon angioplasty. Records of more than 110,000 heart attack patients treated between January 1999 and December 2002 were analyzed.

At first glance, the results showed that door-to-drug times for minority patients were significantly longer—up to seven minutes for African-Americans—than for white patients, while door-to-balloon times for this group were almost 19 minutes longer. However, once the study factored in the hospitals that were offering treatment, these differences were substantially reduced: it took about five minutes more for African-Americans to receive drugs and nine minutes more for balloon intervention. For other ethnic groups, the differences were reduced even further.

“People who get care quicker when they are having a heart attack are more likely to live, so this is an important difference to understand and address,” said Bradley. “The biggest insight from this paper was that it seems as if there were two levels of difference going on,” said Krumholz. “There’s the level where race/ethnicity differences exist, and although they’re small, they’re disturbing and need to be understood. But a bigger part of the overall difference in treatment by race and ethnicity seems to be explained by the hospitals that people are going to.”

Previously, researchers assumed that racial and ethnic disparities were due to differential treatment inside the hospital, without considering the possibility that hospitals that treat greater numbers of minority patients do not offer the same level of care as hospitals that treat fewer minority patients. “Our finding suggests that the issue is bigger than differential treatment inside the hospital. Minority patients tend to be treated at hospitals with poorer quality in this area generally,” Bradley said.

The study suggests that efforts focusing solely on racial and ethnic disparities will fall short in improving patient care. Hospitals need to examine how they’re delivering care and formulate systems that address inadequacies. “As one solution, we should really identify the characteristics and key processes that raise the quality of hospitals generally and ensure that we target these kinds of improvement efforts in hospitals that have poorer quality indicators, many of which are hospitals where minorities receive their care,” Bradley said.