Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review

Hall, William J.; Chapman, Mimi V.; Lee, Kent M.; Merino, Yesenia; Thomas, Tainayah; Payne, B. Keith; Eng, Eugenia; Day, Steven H.; Coyne‐Beasley, Tamera

doi:10.2105/ajph.2015.302903

Cited by 1,654 publications

(1,289 citation statements)

References 63 publications

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“…The roles of racism 13,14 and bias 43 in health care inequalities also deserves further investigation. The Institute of Medicine found that “bias, stereotyping, prejudice, and clinical uncertainty on the part of healthcare providers may contribute to racial and ethnic disparities in healthcare.” 44 Sigurdson et al 45 summarized provider and family experiences with unequal NICU care and characterized them as neglectful, judgmental, or systems based, targeting families rather than infants.…”

Section: Discussionmentioning

confidence: 99%

Racial Segregation and Inequality in the Neonatal Intensive Care Unit for Very Low-Birth-Weight and Very Preterm Infants

et al. 2019

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IMPORTANCE Racial and ethnic minorities receive lower-quality health care than white non-Hispanic individuals in the United States. Where minority infants receive care and the role that may play in the quality of care received is unclear. OBJECTIVE To determine the extent of segregation and inequality of care of very low-birth-weight and very preterm infants across neonatal intensive care units (NICUs) in the United States. DESIGN, SETTING, AND PARTICIPANTS This cohort study of 743 NICUs in the Vermont Oxford Network included 117 982 black, Hispanic, Asian, and white infants born at 401 g to 1500 g or 22 to 29 weeks’ gestation from January 2014 to December 2016. Analysis began January 2018. MAIN OUTCOMES AND MEASURES The NICU segregation index and NICU inequality index were calculated at the hospital level as the Gini coefficients associated with the Lorenz curves for black, Hispanic, and Asian infants compared with white infants, with NICUs ranked by proportion of white infants for the NICU segregation index and by composite Baby-MONITOR (Measure of Neonatal Intensive Care Outcomes Research) score for the NICU inequality index. RESULTS Infants (36 359 black [31%], 21 808 Hispanic [18%], 5920 Asian [5%], and 53 895 white [46%]) were segregated among the 743 NICUs by race and ethnicity (NICU segregation index: black: 0.50 [95% CI, 0.46–0.53], Hispanic: 0.58 [95% CI, 0.54–0.61], and Asian: 0.45 [95% CI, 0.40–0.50]). Compared with white infants, black infants were concentrated at NICUs with lower-quality scores, and Hispanic and Asian infants were concentrated at NICUs with higher-quality scores (NICU inequality index: black: 0.07 [95% CI, 0.02–0.13], Hispanic: −0.10 [95% CI, −0.17 to −0.04], and Asian: −0.26 [95% CI, −0.32 to −0.19]). There was marked variation among the census regions in weighted mean NICU quality scores (range: −0.69 to 0.85). Region of residence explained the observed inequality for Hispanic infants but not for black or Asian infants. CONCLUSIONS AND RELEVANCE Black, Hispanic, and Asian infants were segregated across NICUs, reflecting the racial segregation of minority populations in the United States. There were large differences between geographic regions in NICU quality. After accounting for these differences, compared with white infants, Asian infants received care at higher-quality NICUs and black infants, at lower-quality NICUs. Explaining these patterns will require understanding the effects of sociodemographic factors and public policies on hospital quality, access, and choice for minority women and their infants.

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Section: Discussionmentioning

confidence: 99%

Racial Segregation and Inequality in the Neonatal Intensive Care Unit for Very Low-Birth-Weight and Very Preterm Infants

et al. 2019

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“…These perceptions are reinforced when providers use dominant communication and display an attitude that is not collaborative, warm, friendly, and respectful when interacting with AA patients. 29 In addition to preconceptions about Caucasian providers, AAs also rely on previous experiences as reasons for their mistrust of providers. Because AAs have higher rates of public insurance and not being insured, they may expect financial discrimination in the health care system.…”

Section: Discussionmentioning

confidence: 99%

Perceived Discrimination and Reported Trust and Satisfaction in African Americans: The Jackson Heart Study

2017

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Objectives: 1) To examine the association of multiple dimensions of discrimination with reported trust and satisfaction with providers; 2) to report within-group differences among African Americans (AAs). Methods: Descriptive cross sectional study. The study population included AAs aged 35 to 84 years from the Jackson Heart Study (JHS) (N=5,301). Poisson regression (PR) was used to quantify the association between perceived discrimination and reported trust and satisfaction with providers before and after controlling for selected characteristics. Main Measures: Measures of perceived discrimination included everyday, lifetime, burden from lifetime discrimination, and stress from discrimination. Outcomes included trust and satisfaction with providers. Results: The mean everyday discrimination score was 2.11 (SD±1.02), and the mean lifetime discrimination score was 2.92 (SD±2.12). High (vs low) levels of everyday discrimination were associated with a 3% reduction in the prevalence of trust in providers (PR .97, 95% CI .96, .99) in all models. In fully-adjusted models, high (vs low) lifetime discrimination was associated with a 4% reduction in the prevalence of trust and satisfaction (PR .96, 95% CI .95, .98). Burden of discrimination was not associated with trust or satisfaction, but stress from discrimination was inversely associated with satisfaction. Conclusions: The significant association between discrimination and mistrust and dissatisfaction suggests that health care providers should be made aware of AA perceptions of discrimination, which likely affects their levels of trust and satisfaction.Ethn Dis. 2017;27(3):209-216; doi:10.18865/ed.27.3.209

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“…Additionally, in interactions with the healthcare system, African Americans report lower quality of care and may suffer from implicit racial bias of their providers. 32 In general and within the cohort, African Americans are more often of low SES (Appendix Table 2), which is known to adversely affect mortality outcomes, 33 even after adjustment for individual lifestyle behaviors. 34,35 Additionally, in comparison with white Americans, on average, African Americans have less wealth, defined as total monetary assets minus debts.…”

Section: Discussionmentioning

confidence: 99%

Combined Impact of Health Behaviors on Mortality in Low-Income Americans

Andersen

Wang

Sonderman

et al. 2016

American Journal of Preventive Medicine

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Introduction African Americans and low-income whites have higher mortality than the U.S. general population. This study prospectively investigated the combined influence of major lifestyle factors and poverty on mortality in this vulnerable population. Methods Data were collected in 2002–2009 from 79,101 Southern Community Cohort Study participants, of which 67% were African American and 55% had household incomes <$15,000. Mortality outcomes were identified from the National Death Index though December 31, 2011 (data analyzed in 2014–2015). Healthy behavior scores were created based on tobacco smoking, alcohol intake, diet, physical activity, and sedentary time. The primary analysis was performed based on the score created by counting each participant as having met/not met public health guidelines for each behavior. Results Healthy behavior scores were associated with reduced cancer, cardiovascular disease, and all-cause mortality. Associations were stronger for whites than African Americans: hazard ratios for all-cause mortality comparing participants meeting four or five guidelines versus participants meeting zero were 0.41 (95% CI=0.30, 0.55) for African American men, 0.36 (95% CI=0.24, 0.55) for white men, 0.46 (95% CI=0.36, 0.59) for African American women, and 0.27 (95% CI=0.18, 0.43) for white women. The association between healthy lifestyle and all-cause mortality was weaker among those with incomes <$15,000 than those with higher income, particularly in men (p<0.05 for interaction). Conclusions This study demonstrates the importance of health behaviors on mortality among all groups, but highlights the need for additional research to identify factors contributing to high risk of mortality among low-income and African American populations.

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Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review

Cited by 1,654 publications

References 63 publications

Racial Segregation and Inequality in the Neonatal Intensive Care Unit for Very Low-Birth-Weight and Very Preterm Infants

Racial Segregation and Inequality in the Neonatal Intensive Care Unit for Very Low-Birth-Weight and Very Preterm Infants

Perceived Discrimination and Reported Trust and Satisfaction in African Americans: The Jackson Heart Study

Combined Impact of Health Behaviors on Mortality in Low-Income Americans

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