Perceived Discrimination and Coronary Artery Obstruction
Characteristics of the full sample are presented in Table I. Compared with blacks, whites were significantly older and less likely to be diagnosed with hypertension but were more likely to have had prior revascularization or prior myocardial infarction. Whites reported significantly less discrimination, negative affect, and religiosity, but significantly more social support than blacks. There were no race differences in education, optimism, and diabetes. Overall, 43.9% of participants were at high risk for severe coronary obstruction, based on their nuclear imaging studies; this percentage was similar in blacks and whites. Among the 311 patients who underwent coronary angiography, whites were significantly more likely than blacks to have moderate/severe coronary obstruction (39.0% vs 25.0%).
The final logistic regression models for the nuclear imaging study results are presented inTable II. Among blacks, step 1 (cmodel = 0.66, χ7 = 14.86, P < .05) indicated that prior myocardial infarction and smoking were positively associated with high (vs low/moderate) risk of severe coronary obstruction. In step 2 (cmodel = 0.70, χ4 = 10.36, P < .05), optimism was negatively related to risk of severe coronary obstruction. Finally, step 3 (cmodel = 0.77, χ1 = 13.45, P < .05) indicated that perceived discrimination was associated with an increase in risk of severe coronary obstruction after accounting for the variables in the first 2 steps of the model. Prior myocardial infarction, smoking, and optimism remained significant in the final model.
Among whites, smoking and myocardial infarction were related to high risk of severe coronary obstruction in step 1 (cmodel = 0.59, χ7 = 15.04, P < .05). In step 2 (cmodel = 0.61, χ4 = 14.04, P < .05), optimism was related to lower risk of coronary obstruction. Perceived discrimination was not related to risk of coronary obstruction among whites in step 3 (cmodel = 0.63, χ1 = 1.27, P > .05).
The final logistic regression models for blacks and whites who underwent coronary angiography are presented inTable III. For blacks, step 1 (cmodel = 0.66, χ7 = 11.23, P < .05) indicated that smoking was significantly related to the likelihood of moderate/severe coronary obstruction among blacks. In step 2 (cmodel = 0.79, χ4 = 13.46, P < .05), optimism was related to a lower likelihood of moderate/severe obstruction. In step 3 (cmodel = 0.91, χ1 = 13.08, P < .05), perceived discrimination was significantly related to increased likelihood of moderate/severe obstruction. Among whites, myocardial infarction and smoking were related to an increased likelihood of moderate/severe obstruction in step 1 (cmodel = 0.61, χ7 = 15.88, P < .05). In step 2 (cmodel = 0.65, χ4 = 10.79, P < .05), optimism was again related to a decreased likelihood of moderate/severe obstruction. Perceived discrimination was not associated with obstruction among whites in step 3 (cmodel = 0.68, χ1 = 1.01, P > .05).
Results
Descriptive Statistics
Characteristics of the full sample are presented in Table I. Compared with blacks, whites were significantly older and less likely to be diagnosed with hypertension but were more likely to have had prior revascularization or prior myocardial infarction. Whites reported significantly less discrimination, negative affect, and religiosity, but significantly more social support than blacks. There were no race differences in education, optimism, and diabetes. Overall, 43.9% of participants were at high risk for severe coronary obstruction, based on their nuclear imaging studies; this percentage was similar in blacks and whites. Among the 311 patients who underwent coronary angiography, whites were significantly more likely than blacks to have moderate/severe coronary obstruction (39.0% vs 25.0%).
Logistic Regressions
The final logistic regression models for the nuclear imaging study results are presented inTable II. Among blacks, step 1 (cmodel = 0.66, χ7 = 14.86, P < .05) indicated that prior myocardial infarction and smoking were positively associated with high (vs low/moderate) risk of severe coronary obstruction. In step 2 (cmodel = 0.70, χ4 = 10.36, P < .05), optimism was negatively related to risk of severe coronary obstruction. Finally, step 3 (cmodel = 0.77, χ1 = 13.45, P < .05) indicated that perceived discrimination was associated with an increase in risk of severe coronary obstruction after accounting for the variables in the first 2 steps of the model. Prior myocardial infarction, smoking, and optimism remained significant in the final model.
Among whites, smoking and myocardial infarction were related to high risk of severe coronary obstruction in step 1 (cmodel = 0.59, χ7 = 15.04, P < .05). In step 2 (cmodel = 0.61, χ4 = 14.04, P < .05), optimism was related to lower risk of coronary obstruction. Perceived discrimination was not related to risk of coronary obstruction among whites in step 3 (cmodel = 0.63, χ1 = 1.27, P > .05).
The final logistic regression models for blacks and whites who underwent coronary angiography are presented inTable III. For blacks, step 1 (cmodel = 0.66, χ7 = 11.23, P < .05) indicated that smoking was significantly related to the likelihood of moderate/severe coronary obstruction among blacks. In step 2 (cmodel = 0.79, χ4 = 13.46, P < .05), optimism was related to a lower likelihood of moderate/severe obstruction. In step 3 (cmodel = 0.91, χ1 = 13.08, P < .05), perceived discrimination was significantly related to increased likelihood of moderate/severe obstruction. Among whites, myocardial infarction and smoking were related to an increased likelihood of moderate/severe obstruction in step 1 (cmodel = 0.61, χ7 = 15.88, P < .05). In step 2 (cmodel = 0.65, χ4 = 10.79, P < .05), optimism was again related to a decreased likelihood of moderate/severe obstruction. Perceived discrimination was not associated with obstruction among whites in step 3 (cmodel = 0.68, χ1 = 1.01, P > .05).
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