Abstract 4366982: Sex and Racial Discordance in Referrals for Coronary Artery Calcium Screening at a Large Urban Center

Abstract

Background: Coronary artery calcium(CAC) scoring is a non-invasive tool for detecting subclinical atherosclerosis. In 2022, RUSH University Medical Center launched a low-cost CAC screening initiative to broaden access and enhance early cardiovascular risk detection. This study evaluates referral patterns in a diverse urban population, addressing gaps in prior research. Research Question: Among patients referred for CAC screening at a large urban academic center, do referral patterns differ by patient and provider sex and race/ethnicity? Methods: We conducted a retrospective analysis of Chicago-based patients referred for CAC testing during the promotion(January 2022–December 2023). Demographic data, including sex and race/ethnicity, were collected for patients and referring providers. Descriptive statistics summarized distributions, and associations between patient and provider demographics were assessed using contingency tables. The relationship between patient and provider sex was assessed via Chi-square (X2) (p < 0.05). Results: A total of 931 patients underwent CAC testing during the study period. Of these, 59.4% were female and 40.6% male. Race/ethnicity data were available for 380 patients; 41.7% identified as non-White: Black, Hispanic/Latino, Asian, and other groups. Female providers accounted for 53.3% of referrals, and male providers for 46.7%. Patient-provider sex concordance was strong: 69.1% of female patients were referred by female providers; 69.8% of male patients were referred by male providers. Female providers referred predominantly female patients(77.0%); male providers referred predominantly male patients (60.7%). A significant association was observed between patient and provider sex(X2(1, N = 931) = 136.62, p<0.0001). Patient race also varied by provider sex. Female providers referred a higher proportion of Black patients(27.7% vs. 13.5%); male providers referred more White patients(64.8% vs. 52.8%). This distribution differed significantly by provider sex(X2(4, N = 898) = 29.59, p<0.0001). Conclusion: Significant associations were found between patient and provider sex and race/ethnicity in referrals for CAC screening during a large promotional initiative. Female providers were more likely to refer female and racially diverse patients, while male providers more often referred male and White patients. Understanding these referral patterns may inform provider education and system-level strategies to promote equitable cardiovascular risk assessment.