Racial and ethnic disparities in care - The perspectives of cardiologists

Duke University, Durham, North Carolina, United States
Circulation (Impact Factor: 14.95). 04/2005; 111(10):1264-9. DOI: 10.1161/01.CIR.0000157738.12783.71
Source: PubMed

ABSTRACT Despite extensive documentation of racial and ethnic disparities in care, provider awareness of disparities has been thought to be low. To be effective, educational efforts for physicians must consider providers' knowledge and beliefs about what causes disparities and what can be done about them.
We conducted a Web-based survey of 344 cardiologists to determine their level of awareness of disparities and views of underlying causes. Responses were assessed by means of 5-point Likert scales. Thirty-four percent of cardiologists agreed that disparities existed in care overall in the US healthcare system, and 33% agreed that disparities existed in cardiovascular care. Only 12% felt disparities existed in their own hospital setting, and even fewer, 5%, thought disparities existed in the care of their own patients. Despite this, most respondents rated the strength of the evidence about disparities as "very strong" or "strong." Respondents identified many potential causes for disparities in care but were more likely to endorse patient and system level factors (eg, insurance status or adherence) rather than provider level factors.
Cardiologists' awareness of disparities in care remains low, and awareness is inversely proportional to proximity to their own practice setting.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Insured adults receive invasive cardiovascular procedures more frequently than uninsured adults. We examined the impact of Massachusetts's healthcare reform on use of coronary revascularization procedures, in-hospital and 1-year mortality by race/ethnicity, education, and sex. Using hospital claims data, we compared differences in coronary revascularization rates [coronary artery bypass grafting or percutaneous coronary intervention] and in-hospital mortality by race/ethnicity, education, and sex among Massachusetts residents age 21-64 hospitalized with a principal discharge diagnosis of ischemic heart disease pre (November 1, 2004 to July 31, 2006) and post (December 1, 2006 to September 30, 2008) reform; 1-year mortality was calculated for those undergoing revascularization. Adjusted-logistic regression assessed 24,216 discharges pre-reform and 20,721 discharges post-reform. Blacks had 30% lower odds of receiving coronary revascularization than whites in the pre-reform period. Compared to whites in the post-reform period, blacks (OR=0.73, 95%CI 0.63-0.84) and Hispanics (OR= 0.84, 95%CI 0.74-0.97) were less likely and Asians (OR=1.29, 95%CI 1.01-1.65) more likely to receive coronary revascularization. Patients living in more educated communities, males, and persons with private insurance were more likely to receive coronary revascularization pre and post-reform. Compared to pre-reform, the adjusted odds of in-hospital mortality were higher in patients living in less educated communities in the post-reform period. No differences in 1-year mortality by race/ethnicity, education, or sex for revascularized patients were observed pre- or post-reform. Reducing insurance barriers to receipt of coronary revascularization procedures has not yet eliminated pre-existing demographic and educational disparities in access to these procedures.
    Circulation 04/2014; 129(24). DOI:10.1161/CIRCULATIONAHA.113.005231 · 14.95 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This is a comprehensive narrative review of the literature on the current science and evidence of population-level differences in risk factors for heart disease among different racial and ethnic population in the US. It begins by discussing the importance of population-level risk assessment of heart disease in light of the growth rate of specific minority populations in the US. It describes the population-level dynamics for racial and ethnic minorities: a higher overall prevalence of risk factors for coronary artery disease that are unrecognized and therefore not treated, which increases their likelihood of experiencing adverse outcomes and, therefore, potentially higher morbidity and mortality. It discusses the rate of acute coronary syndrome (ACS) in minority communities. Minority patients with ACS are at greater risk of myocardial infarction, rehospitalization, and death from ACS. They also are less likely than nonminority patients to receive potentially beneficial treatments such as angiography or percutaneous coronary intervention. This paper looks at the data surrounding the increased rate of congestive heart failure in racial and ethnic minorities, where the risk is related to the prevalence of comorbidities with hypertension or diabetes mellitus, which, in combination with environmental factors, may largely explain congestive heart failure disparity. The conclusion is it is essential that health care providers understand these various communities, including nuances in disease presentation, risk factors, and treatment among different racial and ethnic groups. Awareness of these communities' attributes as well as differences in incidence, risk factor burdens, prognosis, and treatment are necessary to mitigate racial and ethnic disparities in heart disease.
    International Journal of General Medicine 08/2014; 7:393-400. DOI:10.2147/IJGM.S65528
  • [Show abstract] [Hide abstract]
    ABSTRACT: Significant racial/ethnic disparities have been documented in cardiovascular care. Although health care quality is improving for many Americans, differences in clinical outcomes have persisted between racial/ethnic minority patients and non-minorities, even when income, education level, and site of care are taken into consideration. Potential causes of disparities are complex and are related to differences in risk factor prevalence and control, use of evidence-based procedures and medications, and social and environmental factors. Minority patients are more likely to receive care from lower-quality health care providers and institutions and experience more barriers to accessing care. Factors such as stereotyping and bias in medicine are hard to quantify, but likely contribute to differences in treatment. Recent trends suggest that some disparities are decreasing. Opportunities for change and improvement exist for patients, providers, and health care systems. Promising interventions, such as health policy changes, quality improvement programs, and culturally targeted community and clinic-based interventions offer hope that high-quality health care in the USA can be provided to all patients.
    Current Cardiology Reports 10/2014; 16(10):530. DOI:10.1007/s11886-014-0530-3