Minorities Receive Lower Quality Healthcare

Institute of Medicine (IOM)

In 1999, Congress requested that the Institute of Medicine (IOM), conduct a study to assess disparities in the kinds and quality of healthcare received by racial and ethnic minorities and non minorities.

The stated purpose of this study was to assess the extent of racial and ethnic differences in health care that are not otherwise attributable to ability to pay or insurance coverage and to evaluate potential sources of racial and ethnic disparities including the role of bias, discrimination and stereotyping. The IOM reported its findings in the 2002 report titled “Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare.”

According to the report, some of the strongest and most consistent evidence of racial and ethnic disparities in care is found in studies of cardiovascular care. The study reports that African-American men and women were treated significantly less than whites with coronary artery bypass graft surgery. African-American patients were also one third less likely to receive cardiovascular services as whites. Moreover, white patients were 50% more likely to receive thrombolytics than black patients. Black patients also waited longer than white patients for their first EKG.

In a study of racial disparities in cancer care, the charts of 7,781 women treated for breast cancer in 107 hospitals were reviewed. This study showed that African-American women were less likely than white women to receive a prognostic test, were less likely to receive radiation therapy in combination with radical/modified mastectomy, and were less likely to receive rehabilitation support services following mastectomy.

In another larger study of 20,000 colorectal cancer patients, it was found that African-Americans were 41% less likely than whites to receive a major procedure fro treatment of colorectal cancer.

In the area of kidney transplants, several studies were consistent in finding that African-American patients are less likely to be judged as appropriate for transplantation, are less likely to appear on transplantation waiting lists, and are less likely to undergo transplantation procedures, even after patients’ insurance status and other factors are considered.

African-Americans with HIV infection are less likely to receive antiretroviral therapy, less likely to receive prophylaxis for pneumocystic pneumonia, and are less likely to receive protease inhibitors than non-minorities with HIV.

Many other areas of medicine revealed similar disparities. In a study of racial differences in total knee arthroplasty among older adult patients, a study concluded that African-Americans were less likely than whites to receive total knee arthroplasty(1.5-2.0 for women and 3.0 to 5.1 for men). Similar disparities were found in the areas of cerebrovascular disease, prenatal and child delivery and lumbar spine treatment.

The study concludes that the healthcare workforce and its ability to deliver quality care for racial and ethnic minorities can be improved substantially by increasing the proportion of underrepresented racial and ethnic minorities among health professionals. In addition, both patients and healthcare providers could benefit from education. Cross cultural curricula should be integrated early into the training of future healthcare providers

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