Access to Coronary Artery Bypass Surgery by Race/Ethnicity and Gender Among Patients Who Are Appropriate for Surgery

Hannan, Edward L.; Ryn, Michelle van; Burke, Jane; Stone, Danice; Kumar, Dinesh; Arani, Djavad T.; Pierce, Walter; Rafii, Shahrokh; Sanborn, Timothy A.; Sharma, Sanjeev; Slater, James; DeBuono, Barbara A.

doi:10.1097/00005650-199901000-00010

Cited by 243 publications

(104 citation statements)

References 29 publications

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“…Many studies have identified differences in the utilization of medical interventions on the basis of sex and race [1,3,4,14,16,19,21,35,38,39,45]. The spectrum of medical interventions, from preventive to diagnostic, is affected by sex and race, even after adjusting for diagnosis and severity of illness.…”

Section: Discussionmentioning

confidence: 99%

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Do Patient Expectations About Arthroplasty at Initial Presentation for Hip or Knee Pain Differ by Sex and Ethnicity?

Lavernia

Contreras

Parvızı

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Section: Discussionmentioning

confidence: 99%

“…Similarly less utilization of some surgical interventions is well documented among women, including orthopaedic procedures [19]. Some interrelated elements may affect services utilization after a patient has entered the medical system, including patient preferences for and acceptance of procedures.…”

Section: Introductionmentioning

confidence: 99%

Do Patient Expectations About Arthroplasty at Initial Presentation for Hip or Knee Pain Differ by Sex and Ethnicity?

Lavernia

Contreras

Parvızı

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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show abstract

“…Our study included a number of rheumatologists, and it is likely that physicians' communications to patients varied, perhaps differing by ethnic group. We suspect, however, that this potential bias may be more marked for lifestyle behavior changes (e.g., sun or pregnancy avoidance) as well as processes such as referral patterns (22), which vary among patients and which are more complex and dependent on physician-patient communication. In contrast, the routine recommendations to take medications and to keep scheduled appointments are usually communicated in systematic ways to all patients (e.g., via prescriptions or written appointments or monitored by additional clinic staff).…”

Section: Discussionmentioning

confidence: 99%

Barriers to treatment adherence among African American and white women with systemic lupus erythematosus

Mosley-Williams¹,

Lumley²,

Gillis³

et al. 2002

Arthritis & Rheumatism

107

108

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Objective. To determine whether African Americans with systemic lupus erythematosus (SLE) have poorer treatment adherence than whites, and to determine ethnic group differences in barriers to adherence, and how barriers affect adherence. Methods. We compared 68 African American and 54 white women with SLE on 19 potential barriers, on 2 adherence behaviors during the past year, and on how the potential barriers relate to each nonadherence behavior. Results. African Americans and whites were similar on most barriers, although African Americans were more likely to rely on religion and were more concerned about long-term medication effects. The 2 ethnic groups were comparable on medication nonadherence, but whites tended to have poorer clinic appointment adherence than African Americans. Finally, we found that barriers related to negative affect (depression, medication concerns, physical symptoms) as well as short-term memory problems and the need for child or elder care were associated with nonadherence among African Americans, whereas perceived treatment inefficacy and lacking trust in physicians were associated with nonadherence among whites. Conclusion. Relationships between adherence barriers and nonadherence may be ethnicity specific, suggesting that interventions to address barriers should be targeted to specific groups.

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“…We focused these vignettes on cardiac care, given the well-supported evidence that blacks and women, despite clinically equivalent circumstances, are less likely to receive cardiac care procedures. 1,[19][20][21][22][23][24][25][26][27][28][29][30][31] Two clinically equivalent options for recommendations, one involving a procedure and the other a non-procedural option, were developed for each vignette. The vignettes were created under the premise that in situations where clinical equivalency does not allow a clear choice, social psychology concepts would suggest that students would then be forced to base their decisions on secondary, non-clinical factors, such as patient demographics.…”

Section: Methodsmentioning

confidence: 99%

Racial, Gender, and Socioeconomic Status Bias in Senior Medical Student Clinical Decision-Making: A National Survey

et al. 2015

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BACKGROUND:Research suggests stereotyping by clinicians as one contributor to racial and gender-based health disparities. It is necessary to understand the origins of such biases before interventions can be developed to eliminate them. As a first step toward this understanding, we tested for the presence of bias in senior medical students. OBJECTIVE: The purpose of the study was to determine whether bias based on race, gender, or socioeconomic status influenced clinical decision-making among medical students. DESIGN: We surveyed seniors at 84 medical schools, who were required to choose between two clinically equivalent management options for a set of cardiac patient vignettes. We examined variations in student recommendations based on patient race, gender, and socioeconomic status. PARTICIPANTS: The study included senior medical students. MAIN MEASURES: We investigated the percentage of students selecting cardiac procedural options for vignette patients, analyzed by patient race, gender, and socioeconomic status. KEY RESULTS: Among 4,603 returned surveys, we found no evidence in the overall sample supporting racial or gender bias in student clinical decision-making. Students were slightly more likely to recommend cardiac procedural options for black (43.9 %) vs. white (42 %, p=.03) patients; there was no difference by patient gender. Patient socioeconomic status was the strongest predictor of student recommendations, with patients described as having the highest socioeconomic status most likely to receive procedural care recommendations (50.3 % vs. 43.2 % for those in the lowest socioeconomic status group, p<.001). Analysis by subgroup, however, showed significant regional geographic variation in the influence of patient race and gender on decision-making. Multilevel analysis showed that white female patients were least likely to receive procedural recommendations. CONCLUSIONS: In the sample as a whole, we found no evidence of racial or gender bias in student clinical decision-making. However, we did find evidence of bias with regard to the influence of patient socioeconomic status, geographic variations, and the influence of interactions b e t w e e n p a t i e n t r ac e a nd g e nd er o n s t u d en t recommendations.

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Access to Coronary Artery Bypass Surgery by Race/Ethnicity and Gender Among Patients Who Are Appropriate for Surgery

Cited by 243 publications

References 29 publications

Do Patient Expectations About Arthroplasty at Initial Presentation for Hip or Knee Pain Differ by Sex and Ethnicity?

Do Patient Expectations About Arthroplasty at Initial Presentation for Hip or Knee Pain Differ by Sex and Ethnicity?

Barriers to treatment adherence among African American and white women with systemic lupus erythematosus

Racial, Gender, and Socioeconomic Status Bias in Senior Medical Student Clinical Decision-Making: A National Survey

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