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June 12, 2002

Racial Disparities in Health Care

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;287(22):2942-2943. doi:10.1001/jama.287.22.2942

To the Editor: Dr Schneider and colleagues1 found that black patients in Medicare managed care organizations (MCOs) had poorer quality of care than white patients. Although numerous studies have reported racial disparities in health care, few have examined whether physician characteristics or treatment recommendations contribute to these disparities.24 We previously reported that Hispanic and black patients with severe coronary artery disease were less likely than white patients to have revascularization recommended after angiography.2 However, hospital records of patients for whom medical therapy was recommended revealed that medical factors, such as diffuse disease, precluded some patients from undergoing the procedure. In addition, nonmedical factors, such as patients' refusal of the physician recommendation for revascularization and preference for conservative medical therapy, contributed to our findings. This suggests that clinical as well as nonclinical or psychosocial factors account for disparities in cardiac care, with overt racial/ethnic discrimination less likely. Such factors cannot be gleaned from large administrative databases such as those used by Schneider et al.

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