Differential perceptions, behaviors, and motivations among African Americans, Latinos, and whites suspected of heart attacks in two hospital populations.

To evaluate the hypothesis that socioeconomic status would exert greater influence on patients' care-seeking behavior than racial/ethnic group status, we undertook a sequential study of African-American, Latino, and white patients hospitalized for acute chest pain from August 1988 through July 1990 at two sites. The study took place in an urban public medical center and an urban private health maintenance organization medical center, which provide care to mixed racial/ethnic groups of lower and middle socioeconomic status, respectively, in Los Angeles. Three concurrent case series of African-American, Latino, and white patients hospitalized for acute chest pain were recruited. The racial/ethnic distribution of the total group was African Americans, 448; Latinos, 487; and whites, 499. The main outcome measure was the length of time patients spent in deciding to seek emergency medical care for acute chest pain and the associated perceptions, behaviors, and motivations involved in deciding to seek care. For the total group, public hospital site and lack of health insurance were the strongest significant predictors of a longer decision phase, whereas differential symptom perceptions, consultation with medical professionals, and use of paramedic transport were significant predictors of shorter duration. Multiple regression results were similar in separate analyses demonstrated significant differences in patients' perceptions of symptom intensity and incapacitation within racial/ethnic groups related to socioeconomic status, as well as in specific behavior and motivation in seeking care. The study concluded that socioeconomic status as determined by hospital site exerted a stronger influence on patients' care-seeking behavior for acute chest pain than racial/ethnic status. Specific care-seeking behaviors of minority and lower-socioeconomic-status patients in the use of medications and paramedics in the face of acute symptoms should be targeted in future educational programs.