Schut Rebecca A
Population Studies Center, University of Pennsylvania, 239 McNeil Building, 3718 Locust Walk, Philadelphia, PA, 19104, USA.
Soc Sci Med. 2021 May;277:113901. doi: 10.1016/j.socscimed.2021.113901. Epub 2021 Apr 6.
Health disparities research often focuses on the social patterning of health outcomes. Increasingly, there has been an emphasis on understanding the mechanisms perpetuating disparities, even after issues of patient access to health services are addressed. The following study utilizes a novel dataset of electronic medical records (EMR), radiology records, and U.S. Census data to investigate the racial/ethnic patterning of provider-patient communication among patients diagnosed with incidental medical findings requiring follow-up. My results indicate that racial/ethnic disparities in follow-up adherence stem from initial disparities in provider-patient communication. These communication disparities persist even after accounting for multiple socioeconomic, health, and provider characteristics, indicating a bias in medicine, whereby providers are less likely to communicate information about incidental medical findings to patients of color relative to White patients. This paper has important clinical implications, as it sheds new light on why we might see low adherence to medical advice among patients of color. Findings also have social, political, and policy relevance, as they suggest an important mechanism through which health inequalities persist. To finally eliminate racial/ethnic health inequalities in the United States, racial bias and discrimination within medical and public health infrastructures must be eliminated.
健康差异研究通常聚焦于健康结果的社会模式。越来越多的研究强调理解使差异持续存在的机制，即使在解决了患者获得医疗服务的问题之后。以下研究利用了一个包含电子病历（EMR）、放射学记录和美国人口普查数据的新数据集，来调查被诊断出有需要随访的偶然医学发现的患者中，医患沟通的种族/族裔模式。我的研究结果表明，随访依从性方面的种族/族裔差异源于医患沟通最初的差异。即使在考虑了多种社会经济、健康和医疗服务提供者特征之后，这些沟通差异仍然存在，这表明医学中存在一种偏见，即相对于白人患者，医疗服务提供者向有色人种患者传达偶然医学发现信息的可能性较小。本文具有重要的临床意义，因为它揭示了为什么我们可能会看到有色人种患者对医疗建议的依从性较低。研究结果也具有社会、政治和政策相关性，因为它们表明了健康不平等持续存在的一个重要机制。为最终消除美国的种族/族裔健康不平等，必须消除医疗和公共卫生基础设施中的种族偏见和歧视。
