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Health Care Disparities
The following charts are from the article Health Care Disparities by Jim Anderson , PA-C, a PA at Harborview Medical Center in Seattle and member of the AAPA Committee on Diversity. This article originally ran in the Jan.-Feb. 2005 issue of ADVANCE for Physician Assistants.
Table 1: Racial and Ethnic Disparities in Cardiovascular Care
- African Americans are 28% more likely to die than white Americans are from cardiovascular disease, yet African Americans are referred less frequently for cardiac catheterization. (1)
- Whites being treated in emergency rooms for chest pain were more likely to receive cardiac catheterization than were African Americans. (2)
- The likelihood of having hospital-based cardiac procedures was consistently greater for whites than it was for African Americans. (3)
- Odds of having a cardiac procedure were nearly three times greater for whites than for African Americans. (4)
- African Americans and Hispanics received less-frequent coronary artery bypass grafts than did whites with similar diagnoses. (5)
- Fewer non-whites underwent cardiac catheterization if they met accepted criteria that are used to determine initiation of the procedure. (6)
- In patients presenting with acute myocardial infarction, African Americans were less likely than whites were to receive thrombolytic therapy, coronary arteriography and coronary artery bypass surgery. (7)
- In patients who were discharged from hospital stays after presenting with definite or possible myocardial infarctions, Mexican Americans received significantly fewer medications than did whites. (8)
References
1. Green A. The human face of health disparities. Public Health Rep. 2003;118:303-308.
2. Bell PD, Hudson S. Equity in the diagnosis of chest pain: race and gender. Am J Health Behav. 2001;25:60-71.
3. Gregory PM, Rhoads GG, Wilson AC, O'Dowd KJ, Kostis JB. Impact of availability of hospital-based invasive cardiac services on racial differences in the use of these services. Am Heart J. 1999;138:507-517.
4. Daumit GL, Hermann JA, Coresh J, Powe NR. Use of cardiovascular procedures among black persons and white persons: a 7-year nationwide study in patients with renal disease. Ann Intern Med. 1999;130:173-182.
5. Hannan EL, van Ryn M, Burke J, et al. Access to coronary artery bypass surgery by race/ethnicity and gender among patients who are appropriate for surgery. Med Care. 1999;37:68-77.
6. Scirica BM, Moliterno DJ, Every NR, et al. Racial differences in the management of unstable angina: results from the multicenter GUARANTEE registry. Am Heart J. 1999;138:1065-1072.
7. Taylor AJ, Meyer GS, Morse RW, Pearson CE. Can characteristics of a health care system mitigate ethnic bias in access to cardiovascular procedures? Experience from the Military Health Services System. J Am Coll Cardiol. 1997;30:901-907.
8. Herholz H, Goff DC, Ramsey DJ, Chan FA, Ortiz C, Labarthe DR, Nichaman MZ. Women and Mexican Americans receive fewer cardiovascular drugs following myocardial infarction than men and non-Hispanic whites: the Corpus Christi Heart Project, 1988-1990. J Clin Epidemiol. 1996;49:279-287.
Table 2: Provider Prejudice and Stereotyping in Clinical Decision-Making
- African American patients were viewed by physicians as less intelligent, less educated, less likely to comply with their advice and more likely to have problems with alcohol and drugs. Physicians also rated African American patients as less likely to be the kind of person whom the physician could have as a friend. (1)
- Using pain-management vignettes in patients who differed only in race, male physicians prescribed higher doses of hydrocodone to whites than to blacks, while female physicians did the opposite. (2)
- Race was noted in 16 of 18 case presentations by residents, but only 19 of 36 cases involving white patients. Race was mentioned in 10 of 10 cases when the resident described black patient's unflattering characteristics, but only four of nine cases where the resident described unflattering characteristics in white patients. (3)
References
1. van Ryn M, Burke J. The effect of patient race and socio-economic status on physicians' perceptions of patients. Soc Sci Med. 2000;50:813-828.
2. Weisse CS, Sorum PC, Sanders KN, Syat BL. Do gender and race affect decisions about pain management? J Gen Intern Med. 2001;16:211-217.
3. Finucane TE, Carrese JA. Racial bias in presentation of cases. J Gen Intern Med. 1990;5:120-121.
Table 3: Selected Recommendations from 'Unequal Treatment'
5-2: Strengthen the stability of patient-provider relationships in publicly funded health plans.
5-3: Increase the proportion of underrepresented U.S. racial and ethnic minorities among health professionals.
5-6: Promote the consistency and equity of care through the use of evidence-based guidelines.
5-8: Enhance patient-provider communication and trust by providing financial incentives for practices that reduce barriers and encourage evidence-based practice.
5-9: Support the use of interpretation services where community need exists.
5-11: Implement multidisciplinary treatment and preventive care teams.
5-12: Implement patient-education programs to increase patients' knowledge of how to best access care and participate in treatment decisions.
6-1: Integrate cross-cultural education into the training of all current and future health professionals.
Adapted from: Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care . Washington , DC : National Academies Press; 2003.
Last Revised: 5/3/06
