A large study of emergency department visits across four states found that Black patients are significantly less likely than White patients to receive diagnostic testing for common symptoms like chest pain, abdominal pain, nausea, and syncope. The disparity raises concerns about missed diagnoses and unequal care.
Researchers analyzed over 3.6 million encounters from 2016 to 2018 and found that White patients discharged from the emergency department were more likely to undergo diagnostic tests, even when presenting with nonspecific symptoms. Black patients had an adjusted odds ratio of 0.74 for receiving related testing, meaning they were 26% less likely to be tested than White patients.
This pattern persisted across income levels, insurance types, and age groups. Even among Medicaid and self-pay patients, Black individuals were consistently less likely to receive diagnostic testing. The disparity was most pronounced in emergency settings, where time pressure and implicit bias may influence decision-making.
The study suggests that while White patients may be subject to more test overuse, Black patients may face undertesting and increased risk of missed diagnoses. Prior research supports this concern, showing higher rates of missed appendicitis and heart attacks among Black patients.
Researchers point to biased triage practices and communication barriers between predominantly White physicians and Black patients as possible contributors. They call for further investigation into whether these disparities lead to worse outcomes and how to ensure equitable diagnostic care.
See: “Race and Ethnicity and Diagnostic Testing for Common Conditions in the Acute Care Setting” (August 27, 2024)
