The National Deficit of Black and Hispanic Physicians in the US and Projected Estimates of Time to Correction

Mora, Hector A.; Obayemi, Adetokunbo; Holcomb, Kevin; Hinson, Maurice

doi:10.1001/jamanetworkopen.2022.15485

Cited by 30 publications

(26 citation statements)

References 3 publications

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“…55 Limited access to Black physicians could contribute to the underrepresentation of Black participants in vaccine trials because racial and ethnic minority groups are more likely to trust a physician from a background similar to their own. 56,57 Additionally, lower trust in biomedical research has been well documented for both Asian and Black communities. 29,51,[58][59][60] The Asian American community in the US nearly doubled in size from 2000 (11.9 million) to 2019 (22.4 million).…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, providing support for indirect expenses such as transportation, childcare, and time off from work could be especially beneficial for underrepresented communities . Limited access to Black physicians could contribute to the underrepresentation of Black participants in vaccine trials because racial and ethnic minority groups are more likely to trust a physician from a background similar to their own . Additionally, lower trust in biomedical research has been well documented for both Asian and Black communities .…”

Section: Discussionmentioning

confidence: 99%

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Sex, Racial, and Ethnic Representation in COVID-19 Clinical Trials

et al. 2023

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ImportanceSince the onset of the COVID-19 pandemic, there have been calls for COVID-19 clinical trials to be fully representative of all demographic groups. However, limited evidence is available about the sex, racial, and ethnic representation among COVID-19 prevention and treatment trials.ObjectiveTo investigate whether female participants and racial and ethnic minority individuals are adequately represented in COVID-19 prevention and treatment trials in the US.Data SourcesIdentified studies were registered on ClinicalTrials.gov or published in the PubMed database from October 2019 to February 2022.Study SelectionIncluded studies must have provided the number of enrolled participants by sex, race, or ethnicity. Only interventional studies conducted in the US for the primary purpose of the diagnosis, prevention, or treatment of (or supportive care for) COVID-19 conditions were included.Data Extraction and SynthesisData on counts of enrollments by demographic variables (sex, race, and ethnicity) and location (country and state) were abstracted. Studies were broadly categorized by primary purpose as prevention (including vaccine and diagnosis studies) vs treatment (including supportive care studies). A random effects model for single proportions was used. Trial estimates were compared with corresponding estimates of representation in the US population with COVID-19.Main Outcomes and MeasuresSex, racial, and ethnic representation in COVID-19 clinical trials compared with their representation in the US population with COVID-19.ResultsOverall, 122 US-based COVID-19 clinical trials comprising 176 654 participants were analyzed. Studies were predominantly randomized trials (n = 95) for treatment of COVID-19 (n = 103). Sex, race, and ethnicity were reported in 109 (89.3%), 95 (77.9%), and 87 (71.3%) trials, respectively. Estimated representation in prevention and treatment trials vs the US population with COVID-19 was 48.9% and 44.6% vs 52.4% for female participants; 23.0% and 36.6% vs 17.7% for Hispanic or Latino participants; 7.2% and 16.5% vs 14.1% for Black participants; 3.8% and 4.6% vs 3.7% for Asian participants; 0.2% and 0.9% vs 0.2% for Native Hawaiian or Other Pacific Islander participants; and 1.3% and 1.4% vs 1.1% for American Indian or Alaska Native participants. Compared with expected rates in the COVID-19 reference population, female participants were underrepresented in treatment trials (85.1% of expected; P &lt; .001), Black participants (53.7% of expected; P = .003) and Asian participants (64.4% of expected; P = .003) were underrepresented in prevention trials, and Hispanic or Latino participants were overrepresented in treatment trials (206.8% of expected; P &lt; .001).Conclusions and RelevanceIn this systematic review and meta-analysis, aggregate differences in representation for several demographic groups in COVID-19 prevention and treatment trials in the US were found. Strategies to better ensure diverse representation in COVID-19 studies are needed, especially for prevention trials.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sex, Racial, and Ethnic Representation in COVID-19 Clinical Trials

et al. 2023

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“…Our analyses highlight that to bring the level of racial-ethnic clinician-patient concordance for Black and Hispanic patients up to parity with the level of clinician-patient concordance for White and Asian/Pacific Islander patients, the expansion of policies to train larger numbers of Black and Hispanic clinicians is essential 44 . Although not all individuals may prefer racial-ethnic concordant clinician-patient relationships, 45 our study suggests that both issues interact multiplicatively: the effect of improved communication, as measured by the SDM index, is larger in many racially ethnically concordant clinician-patient relationships.…”

Section: Discussionmentioning

confidence: 99%

Shared Decision-making Lowers Medical Expenditures and the Effect Is Amplified in Racially-Ethnically Concordant Relationships

Brown,

Hurley,

Rodriguez

et al. 2023

Medical Care

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Background: Racial-ethnic disparities are pervasive in health care. One mechanism that may underlie disparities is variation in shared decision-making (SDM), which encompasses high-quality clinician-patient communication, including deliberative discussions about treatment options. Objectives: To determine whether SDM has causal effects on outcomes and whether these effects are stronger within racial-ethnic concordant clinician-patient relationships. Research Design: We use instrumental variables to estimate the causal effect of SDM on outcomes. Subjects: A total of 60,584 patients from the 2003–2017 Integrated Public Use Microdata Series Medical Expenditure Panel Survey. Years 2018 and 2019 were excluded due to changes in the Medical Expenditure Panel Survey that omitted essential parts of the SDM index. Measures: Our key variable of interest is the SDM index. Outcomes included total, outpatient, and drug expenditures; physical and mental health; and the utilization of inpatient and emergency services. Results: SDM lowers annual total health expenditures for all racial-ethnic groups, but this effect is only moderated among Black patients seen by Black clinicians, more than doubling in size relative to Whites. A similar SDM moderation effect also occurs for both Black patients seen by Black clinicians and Hispanic patients seen by Hispanic clinicians with regard to annual outpatient expenditures. There was no significant effect of SDM on self-reported physical or mental health. Conclusions: High-quality SDM can reduce health expenditures without negatively impacting overall physical or mental health, supporting a business case for health care organizations and systems to improve racial-ethnic clinician-patient concordance for Black and Hispanic patients.

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“…As of 2015, there is estimated to be a deficit of about 114,000 Black and 81,000 Hispanic doctors compared to what one would expect from proportions of the US population ( 3 ). This dearth is at least partially historical: Racial and ethnic minorities were excluded from attending medical school and joining medical organizations, such as the American Medical Association (AMA).…”

Section: Race In Admissionsmentioning

confidence: 99%

“…The schools can then use any metrics and recommendations second-hand. Such structuring is common for tax purposes, for separating nonprofit from political activities (i.e., 501(c)( 3 ) vs. 502(c)( 4 )), and for reducing tort liability. Medical schools should consult with attorneys as soon as possible to plan organizational offshoots that can consider race.…”

Section: Maintaining and Improving Diversitymentioning

confidence: 99%