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Research Letter
Health Care Policy and Law
July 19, 2021

Racial and Ethnic Disparities in Outpatient Visit Rates Across 29 Specialties

Author Affiliations
  • 1Department of Medicine, Internal Medicine Residency Program at Brigham and Women’s Hospital/Harvard Medical School, Boston, Massachusetts
  • 2Cambridge Health Alliance/Harvard Medical School, Cambridge, Massachusetts
  • 3Department of Community Health, Tufts University, Medford, Massachusetts
  • 4City University of New York at Hunter College, New York City
  • 5Planned Parenthood South Texas, San Antonio
JAMA Intern Med. Published online July 19, 2021. doi:10.1001/jamainternmed.2021.3771

Access to the full range of medical specialties is a cornerstone of high-quality medical care. However, many patients, especially members of racial and ethnic minority groups, face barriers to such care. We examined nationwide racial/ethnic disparities in outpatient visit rates to 29 physician specialties.

We pooled data on adults 18 years or older from the 2015 to 2018 Medical Expenditure Panel Survey (MEPS), which collects demographic (including self-reported race/ethnicity) and health care utilization data from a nationally representative sample of the noninstitutionalized, civilian US population. We tabulated office and outpatient department visits to each physician specialty and calculated adjusted rate ratios (ARRs) for each racial/ethnic minority group (compared with the White population) using negative binomial regression adjusted for age. In sensitivity analyses, we adjusted for sex, self-reported health, health insurance, education level, and income.

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    1 Comment for this article
    In Response to Racial and Ethnic Disparities in Outpatient Visit Rates
    Eric Chang, MD | Morehouse School of Medicine
    We thank Cai et al. for demonstrating the racial and ethnic disparities amongst patients who visit outpatient medical and surgical facilities.1 The authors note several contributing factors to this underrepresentation of minorities such as shortage of physicians and thus specialist referrals, racism in healthcare leading to distrust, and decreased appointment scheduling in Medicaid or uninsured patients.1

    Distrust of the healthcare system amongst minority groups is prevalent, which may be attributed to a cultural memory of victimization and exploitation during clinical experiments such as the Tuskegee study as well as personal experience with discrimination.2 This mistrust fuels additional economic
    and social inequities, exacerbating underlying racial, ethnic, health, and healthcare disparities.3 These factors may then lead to a decreased utilization of outpatient medical and surgical specialty services due to a sense of suspicion and distrust.

    However, another contributor to such disparities is the increased utilization of complementary and alternative medicine (CAM) (i.e., acupuncture, home remedies, herbal medicine) to manage chronic conditions. Ethnic minorities have higher utilization of CAM4, which may be due to these alternative medical modalities being more congruent with their personal values and beliefs. This multifaceted utilization of CAM as an adjunct, or primary, health management modality due to its perceived safe or natural properties may limit the desire or need to pursue traditional outpatient medical follow-up.

    Addressing racial and ethnic disparities is a step towards reducing health and healthcare disparities. Minorities experience higher rates of acute and chronic illnesses5, which leads to additional healthcare cost burdens on the community. As the US Census Bureau continues to project a more racially and ethnically diverse nation, we must invest in measures to address racial and ethnic disparities while rebuilding trust between the minority community and healthcare providers in the in- and outpatient settings.

    Kisha Burgess1 DO; Hee Kyung Lee2 BS; Eric Y Chang1 MD

    1Morehouse School of Medicine, Atlanta, GA
    2Medical College of Georgia, Augusta, GA

    1) Cai C, Gaffney A, McGregor A, et al. Racial and Ethnic Disparities in Outpatient Visit Rates Across 29 Specialties. JAMA Intern Med. Published online July 19, 2021. doi:10.1001/jamainternmed.2021.3771

    2) Rajakumar K, Thomas SB, Musa D, Almario D, Garza MA. Racial Differences in Parents' Distrust of Medicine and Research. Arch Pediatr Adolesc Med. 2009;163(2):108–114. doi:10.1001/archpediatrics.2008.521

    3) Gibbons J. The Effect of Segregated Cities on Ethnoracial Minority Healthcare System Distrust. City & Community. 2019;18(1):321-343. doi:10.1111/cico.12370

    4) Agu JC, Hee-Jeon Y, Steel A, Adams J. A Systematic Review of Traditional, Complementary and Alternative Medicine Use Amongst Ethnic Minority Populations: A Focus Upon Prevalence, Drivers, Integrative Use, Health Outcomes, Referrals and Use of Information Sources. J Immigr Minor Health. 2019 Oct;21(5):1137-1156. doi: 10.1007/s10903-018-0832-4. PMID: 30382488.

    5) Webb Hooper M, Mitchell C, Marshall VJ, Cheatham C, Austin K, Sanders K, Krishnamurthi S, Grafton LL. Understanding Multilevel Factors Related to Urban Community Trust in Healthcare and Research. Int J Environ Res Public Health. 2019 Sep 6;16(18):3280. doi: 10.3390/ijerph16183280. PMID: 31500126; PMCID: PMC6765868.