• Posted May 16, 2022

Hispanics Wait Half-Hour Longer in ER When Chest Pain Strikes

When Hispanic Americans arrive in the emergency room with chest pain, they have to wait longer for care than other people with the same symptoms, a preliminary study finds.

Chest pain, a potential sign of heart attack, is one of the leading reasons people end up in an ER. But the new findings suggest that Hispanic patients may face unnecessary delays in either receiving care, being admitted to the hospital or being discharged home.

The study, done at one hospital in Atlanta, found that among 11,000-plus people arriving in the ER with chest pain, Hispanic individuals waited an average of a half-hour longer than white, Black and Asian patients.

These delays persisted even after patients were admitted to the hospital. Compared with patients of other backgrounds, Hispanic patients waited twice as long for a final treatment plan, the study found.

The reasons for the disparities are not fully clear. But lead researcher Dr. Katiria Pintor Jimenez pointed to one possible factor: There are too few Hispanic physicians.

Other research has shown that nationally, Black and Hispanic Americans are underrepresented in the medical field: A study last year found that by 2019, Hispanic women and men accounted for only 2.5% to 4% of physicians nationwide.

Yet Hispanic people are one of the fastest-growing populations in the United States, noted Pintor Jimenez, an internal medicine resident at Morehouse School of Medicine in Atlanta.

Language barriers may be one reason for Hispanic patients' delays in care, she said, so having more Spanish-speaking providers can help surmount that. Beyond language, though, when patients and physicians have a shared cultural experience, that can support trust and communication.

"We need more Hispanic physicians," Pintor Jimenez said.

She presented the findings on Friday at a meeting of the American Heart Association (AHA) focused on quality of care, being held in Reston, Va. Studies released at meetings are generally considered preliminary until they are published in a peer-reviewed journal.

The findings are based on medical records from more than 11,000 people who arrived at Grady Memorial Hospital's ER in 2020, all with chest pain as their primary complaint.

On average, Hispanic people waited 99 minutes to receive treatment, be admitted to the hospital or be discharged from ER -- versus 71 minutes among all other patients. And among patients admitted to the hospital, Hispanic patients faced a delay in getting a treatment plan, such as further testing: They waited an average of 86 minutes, while other patients waited half as long.

"This is one hospital in one city, but it adds to the growing story of health disparities in the U.S.," said Dr. Felipe Lobelo, a member of the AHA's Council on Lifestyle and Cardiometabolic Health.

He agreed that language barriers may help explain the longer wait times for Hispanic patients, as could lack of health insurance, which can add a layer of "logistical" issues in getting admitted to the hospital, for instance.

Hispanic patients in the study were nearly three times more likely to be uninsured than their white, Black and Asian counterparts.

Beyond that, Lobelo said, there could be "unconscious biases" that make health care providers think Hispanic patients' symptoms are less urgent. He noted, for example, that Hispanic patients in this study tended to be younger than other patients, which might make providers take their complaints less seriously.

Pintor Jimenez said it would be valuable for more health care systems to evaluate their performance and see whether they have disparities in care like those found in this study.

Hispanic patients, she said, have a right to "culturally competent" care -- a term that refers to health care systems' ability to provide care to patients with diverse values, beliefs and behaviors.

"Educating health care professionals in cultural competency is of paramount importance to address and reduce health disparities for Hispanic people," Pintor Jimenez said.

Lobelo agreed that health care systems can look at their own performance and "try to course-correct" when disparities are detected. One potential way, he said, is to develop more efficient ways to get patients admitted even when health insurance information is lacking.

As for patients, Lobelo said, "you have to advocate for yourself. It's OK to ask to see a doctor as soon as possible."

Ultimately, though, what needs to be tackled are the underlying systemic factors that feed health disparities, according to Lobelo.

"We know, at the end of the day, that systemic racism is complex," he said. "It will require a concerted effort by multiple stakeholders to address it."

More information

The U.S. Centers for Disease Control and Prevention has more on the health of Hispanic Americans.

SOURCES: Katiria Pintor Jimenez, MD, internal medicine resident, Morehouse School of Medicine, Atlanta; Felipe Lobelo, MD, PhD, member, Council on Lifestyle and Cardiometabolic Health, American Heart Association, Dallas, and associate professor, Rollins School of Public Health, Emory University, Atlanta; American Heart Association Quality of Care and Outcomes Research Scientific Sessions, Reston, Va., presentation, May 13, 2022