Racial differences in the elderly's use of medical procedures and diagnostic tests.

Escarce, José J.; Epstein, Kenneth R.; Colby, David C.; Schwartz, J. Sanford

doi:10.2105/ajph.83.7.948

Cited by 290 publications

(156 citation statements)

References 37 publications

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“…One recent analysis of Medicare data [22] found that African American and low-income patients were less likely to have ambulatory physician visits, mammograms, and influenza immunizations, but that such individuals were more likely to be hospitalized or to die. Similarly, Escarce and colleagues [23] found that elderly whites were more likely than were elderly African Americans to receive 23 different procedures and tests, with whites receiving more and newer services or those requiring higher technology. Rosenheck, Fontana, and Cottrol [48] found that African American veterans who were provided mental health services from white clinicians received fewer services.…”

Section: Brief Background Of the Usphs-tuskegee Syphilis Study And Rementioning

confidence: 95%

“…Similarly, the clear evidence that African Americans frequently receive lower quality care from the health care system than do whites [22,23] is another factor potentially leading to distrust in the health care system and, in turn, to distrust of health care researchers. For example, although coronary heart disease (CHD) is the leading cause of death for African Americans in the United States [24,25], and cardiac revascularization procedures are well-established treatments for cardiovascular disease [26,27], a smaller proportion of African American patients than white patients receive such procedures in Veterans Administration (VA), Medicare, and other populations [28][29][30][31][32][33].…”

Section: Brief Background Of the Usphs-tuskegee Syphilis Study And Rementioning

confidence: 99%

“…Research on racial differences in health care utilization has clearly demonstrated that African Americans have less access to health care than do their white counterparts [23,32,43,47]. There are wide disparities in the use of particular medical services, even when access is equalized by similar insurance coverage.…”

Section: Brief Background Of the Usphs-tuskegee Syphilis Study And Rementioning

confidence: 99%

See 2 more Smart Citations

The Tuskegee Legacy Project: history, preliminary scientific findings, and unanticipated societal benefits

Katz

Kegeles

Green

et al. 2003

Dental Clinics of North America

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SummaryThis article is intended to provide a relatively complete picture of how a pilot study-conceived and initiated within an NIDCR-funded RRCMOH-matured into a solid line of investigation within that center and "with legs"into a fully funded study within the next generation of NIDCR centers on this topic of health disparities, the Centers for Research to Reduce Oral Health Disparities. It highlights the natural opportunity that these centers provide for multicenter, cross-disciplinary research and for research career pipelining for college and dental school students; with a focus, in this case, on minority students.Furthermore, this series of events demonstrates the rich potential that these types of research centers have to contribute in ways that far exceed the scientific outcomes that form their core. In this instance, the NMOHRC played a central-and critical, if unanticipated-role in contributing to two events of national significance, namely the presidential apology to the African American community for the research abuses of the USPHS-Tuskegee syphilis study and the establishment of the National Center for Bioethics in Research and Health Care at Tuskegee University. Origins of the Tuskegee Legacy ProjectThe Tuskegee Legacy Project (TLP) has its origins in casual Web surfing by a biomedical reference librarian on her laptop computer on a fall evening in 1993 while relaxing in the dormer room, which served as the family den. Ms. B.J. Frey, Head Reference Librarian at the * Corresponding author. E-mail address: ralph.katz@nyu.edu (R.V. Katz).This research project was supported by NIDCR/NIH grant #P50 DE10592 (University of Medicine and Dentistry of New Jersey/ University of Connecticut Northeastern Minority Oral Health Research Center), and is currently supported in the analysis phase by NIDCR/NIH grant #U54 DE 14257 (NYU Oral Cancer RAAHP Center).Research Centers supported by the NIH are fully intended to create a vortex of scientific activity that goes well beyond the direct scientific aims of the studies initially funded within those centers. The maxim is that the whole should be greater than the sum of its initial constituent studies or parts. We believe that NMOHRC did indeed achieve that maxim-even extending "the whole" to include broad societal impact, well beyond the scope of important, but mere, scientific outcomes-all within the concept and appropriate functions of a scientific NIHfunded research center. NIH Public Access

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Section: Brief Background Of the Usphs-tuskegee Syphilis Study And Rementioning

confidence: 95%

Section: Brief Background Of the Usphs-tuskegee Syphilis Study And Rementioning

confidence: 99%

Section: Brief Background Of the Usphs-tuskegee Syphilis Study And Rementioning

confidence: 99%

See 1 more Smart Citation

The Tuskegee Legacy Project: history, preliminary scientific findings, and unanticipated societal benefits

Katz

Kegeles

Green

et al. 2003

Dental Clinics of North America

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“…11,12 In addition, it has been noted that blacks have lower rates than whites of utilization of high-technology cardiology services including coronary angiography, angioplasty, and revascularization, [13][14][15][16] as well as other cardiovascular treatments. [17][18][19] It has also been suggested that fatal cardiovascular disease in blacks involves less atherosclerosis of the epicardial coronary arteries than among whites. 7 Most of what is known about the effects of hypertension on mortality in blacks versus whites is based on information derived from epidemiological studies, clinical trials of drug treatment, or anecdotal clinical experience.…”

mentioning

confidence: 99%

Hypertensive Vascular Disease as a Cause of Death in Blacks Versus Whites

Onwuanyi

Hodges²,

Avancha³

et al. 1998

Hypertension

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Abstract-Cardiovascular disease is the major cause of excess mortality among urban US blacks, but autopsy data comparing black-white differences in underlying pathological causes of cardiovascular death are lacking. We reviewed all 720 adult cases autopsied in 1991 in the New York City Medical Examiner's Office in which the coded cause of death was cardiovascular disease (International Classification of Diseases, 9th Revision, codes 391, 393 to 398, 401 to 404, 410, 411, 414 to 417, 420 to 438, and 440 to 444). After exclusion of 133 cases because race was missing or coded as other than black or white, gender was not coded, or there was an unusual circumstances of death or extreme obesity, 587 cases were available for analysis. There were 314 black and 273 white subjects. Black women were younger than white women at time of death (mean age, 54.7 versus 61.5 years; PϽ.001), whereas black and white men did not differ in mean age at death. Hypertensive vascular disease was the autopsy cause of death in 42% of blacks compared with 23% of whites (PϽ.001). Conversely, atherosclerotic heart disease was the autopsy cause of death in 64% of white subjects but only 38% of blacks. These patterns were consistent in both sexes and after adjustment for age. Hypertensive vascular disease was far more common than atherosclerotic heart disease as the cause of death at autopsy among blacks compared with whites in New York City, whereas atherosclerotic heart disease was more common in whites. These findings suggest that ineffective control of hypertension is a major factor contributing to excess cardiovascular mortality among urban blacks. (Hypertension. 1998;31:1070-1076.)

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“…1 Flow chart of participation in senior medical student survey regional differences in recommendations. 33,34 To search for similar geographic patterns in our findings, we grouped students by the Association of American Medical Colleges (AAMC) approach to regional grouping of states: Northeast, South, Central, and West (Appendix). 35 We also used each school's self-description (obtained from its website) as "public" or "private" to categorize the schools.…”

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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Racial differences in the elderly's use of medical procedures and diagnostic tests.

Cited by 290 publications

References 37 publications

The Tuskegee Legacy Project: history, preliminary scientific findings, and unanticipated societal benefits

The Tuskegee Legacy Project: history, preliminary scientific findings, and unanticipated societal benefits

Hypertensive Vascular Disease as a Cause of Death in Blacks Versus Whites

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

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