Purpose: Medical treatments involve risk. Hence, patients' willingness to take risks (their risk preferences) may influence treatment decisions. However, patients' risk perceptions (i.e., how much risk is involved) are equally important and may be inaccurate. We examined whether risk preferences and perceptions about three specific cardiovascular procedures differ by race in a cohort of cardiovascular patients, and whether these differences might be related to belief in luck, religiosity, trust in physicians and second-hand experience with the procedures.

Methods: 162 African American and 348 Caucasian subjects were recruited from two Nuclear Cardiology clinics and one community-based study. Patients were eligible if they were 40+ years old and had not had bypass surgery or angioplasty. Subjects completed instruments to measure health risk preferences and risk perceptions related to cardiac bypass surgery (CABG), cardiac catheterization and angioplasty. Belief in luck, religious belief and trust in physicians were measured using existing scales. Second-hand experiences were measured by asking how many relatives and friends they knew who had had good and bad outcomes with each of the three procedures.

Results: Health risk preferences did not vary by race (Kolmogorov-Smirnov (KS) Z=.82, p>.1), but risk perceptions did. African Americans believed complications rates associated with the procedures were higher than Caucasians (Kruskall-Wallis test statistics =7.6, p<.01 for CABG; 9.7, p<.01 for cardiac catheterization; and 8.2, p<.01 for angioplasty). There were racial differences in religiosity, belief in personal bad luck and second-hand experiences with the procedures. Religiosity was significantly higher in African Americans (KS Z=2.8, p<.001) while belief in personal bad luck was lower (KS Z=1.4, p<.05). Caucasians knew, on average, significantly more people who had had good outcomes with the three procedures than did African Americans. However, there was no statistically significant racial difference in terms of the number of people subjects knew who had had bad outcomes with these procedures.

Conclusions: Differences in second-hand experiences might explain racial differences in the perception of risk for cardiovascular procedures, which might lead Caucasians to be more willing to undergo these procedures. A greater religious belief and lower belief in personal bad luck might lead African Americans to believe that they had less need to undergo these invasive treatments. These results do suggest that the role of risk preferences and perceptions warrant further investigation.