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Racial and ethnic disparities in care have been consistently documented in the treatment and outcomes of many common clinical diseases. The 2003 Institute of Medicine (IOM) report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare,” defines disparities as differences in the treatment that are not directly attributable to access-related factors, clinical needs, patient preferences, or appropriateness of intervention (Figure 3-1). The elimination of health care disparities is a high priority for the federal government and several academic organizations.

Figure 3-1

Defining differences, disparities, and discrimination in populations with equal access to healthcare. (Reproduced, with permission, from Smedley BD, Stith AY, Nelson AR. Unequal treatment. Confronting racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2002.)

Documented disparities of disease prevention and treatment include rates of vaccination, cancer screening, secondary prevention of myocardial infarction (MI), transplant surgery, curative surgery, and angioplasty. Disparities in health outcomes include cardiovascular disease, HIV/AIDS, diabetes, cancer, asthma, pregnancy outcomes, mental health, and hospitalization.

Specific examples include the following (Table 3-1):

Table 3-1 Racial/Ethnic Disparities in Disease Prevention, Treatment, and Outcomes*

  • A higher risk of stroke, heart failure, and renal failure associated with hypertension (African Americans)
  • A higher rate of complications from diabetes (African Americans and Native Americans)
  • Later-stage colon, breast, and prostate cancer at presentation (African Americans)
  • Less aggressive evaluation and treatment: curative lung cancer resection, cardiac catheterization, peripheral angioplasty, renal transplantation (African Americans)
  • Diabetic more likely to receive amputations (African Americans)
  • Higher death rates per 1000 hospital admissions in low mortality diagnosis related groups (African Americans, Hispanics, and the uninsured)

The observed racial/ethnic health care disparities have multifactorial etiologies. Patients face multiple barriers as they engage the health care system: (1) personal ...

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