Impact of Patient–Provider Race, Ethnicity, and Gender Concordance on Cancer Screening: Findings from Medical Expenditure Panel Survey

Abstract

Racial and ethnic minorities experience lower rates of cancer screening compared with non-Hispanic whites (NHWs). Previous studies evaluating the role of patient-provider race, ethnicity, or gender concordance in cancer screening have been inconclusive. In a cross-sectional analysis using the Medical Expenditure Panel Survey (MEPS), data from 2003 to 2010 were assessed for associations between patient-provider race, ethnicity, and/or gender concordance and, screening (American Cancer Society guidelines) for breast, cervical, and colorectal cancer. Multivariable logistic analyses were conducted to examine associations of interest. Of the 32,041 patient-provider pairs in our analysis, more than 60% of the patients were NHW, 15% were non-Hispanic black (NHB), and 15% were Hispanic. Overall, patients adherent to cancer screening were more likely to be non-Hispanic, better educated, married, wealthier, and privately insured. Patient-provider gender discordance was associated with lower rates of breast [OR, 0.83; 95% confidence interval (CI), 0.76-0.90], cervical (OR, 0.83; 95% CI, 0.76-0.91), and colorectal cancer (OR, 0.84; 95% CI, 0.79-0.90) screening in all patients. This association was also significant after adjusting for racial and/or ethnic concordance. Conversely, among NHWs and NHBs, patient-provider racial and/or ethnic concordance was not associated with screening. Among Hispanics, patient-provider ethnic discordant pairs had higher breast (58% vs. 52%) and colorectal cancer (45% vs. 39%) screening rates compared with concordant pairs. Patient-provider gender concordance positively affected cancer screening. Patient-provider ethnic concordance was inversely associated with receipt of cancer screening among Hispanics. This counter-intuitive finding requires further study. Our findings highlight the importance of gender concordance in improving cancer screening rates. .

Impact of Diagnosing Urologists and Hospitals on the Use of Radical Cystectomy

“…Our study showed that concordance between urologist sex and sex of the patient increased radical cystectomy utilization between female patients seen by female urologists. This finding serves as a potential opportunity to improve the utilization of radical cystectomy in line with prior studies that have shown that gender concordance between providers and patients can improve clinical outcomes [27] . Despite a significant proportion of women receiving a radical cystectomy, there was a dearth of female urologists, which might in part explain the overall underutilization of radical cystectomy.…”

Patient–physician gender concordance and increased mortality among female heart attack patients

“…However, distressingly, in the absence of gender concordance between advocates and those they advocate for-particularly in instances where men are advocating for women-women have been found to fare worse than their male counterparts, facing disadvantages in terms of pay equality (1), ascension to leadership positions (2), educational outcomes (3), legal dispute resolution (4), and even medical treatment (5). In the medical setting, research suggests that gender discordance may yield lower rapport and patient satisfaction (6), reduced adherence to preventative care protocols (7), and weaker patient-physician communication (8).…”

Disparities in human papillomavirus–related cancer incidence and survival among human immunodeficiency virus–infected Hispanics living in the United States

“…The screening and treatment of precancerous lesions at recommended intervals can prevent cervical cancer, and specific recommendations have been issued for HIV‐infected women for cytological screening with the addition of HPV testing . Higher cervical cancer rates suggest that HIV‐infected Hispanic women may be receiving inadequate screening services, similarly to what has been observed in the general population, although there is little information on screening rates specific to this group. Barriers to screening among HIV‐infected women may include a fear of disclosing their HIV status to providers, a lack of centralized clinical services, and preferential attention to other aspects of HIV care .…”