Racial and ethnic disparities in access to physicians with HIV-related expertise.
OBJECTIVE
Professional medical associations recommend that physicians who treat patients with human immunodeficiency virus (HIV) have a measurable form of disease-specific expertise, such as high HIV patient volume or infectious diseases certification. Although it is known that racial/ethnic minorities generally have worse access to care than do whites, previous work has not examined disparities in the use of physicians with HIV-related expertise.


METHODS
We linked data from a prospective cohort study of 2,207 persons with HIV receiving care in the United States with a cross-sectional survey of 404 physicians caring for them. Using multivariate analysis, we estimated the association of patient race/ethnicity with the experience and training of their physicians, controlling for health status, socioeconomic status, demographic characteristics, and geographic variation in provider supply.


RESULTS
Compared with white patients, African Americans were less likely to have an infectious diseases specialist as a regular source of care (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.37 to 0.95). Persons of Alaskan Native, American Indian, Asian, Pacific Islander, or mixed racial background were also less likely than whites to have an infectious diseases specialist (OR, 0.44; 95% CI, 0.23 to 0.83). Conversely, Latino patients had physicians whose HIV patient volume was, on average, 24% higher than the physicians of white patients (incident rate ratio, 1.24; 95% CI, 1.03 to 1.50).


CONCLUSIONS
Some groups of racial/ethnic minorities are less likely than are whites to have infectious diseases specialists as a regular source of care. The finding that the physicians of Latino patients had relatively higher HIV caseloads suggests that this particular patient subpopulation has access to HIV expertise. Further work to explain racial/ethnic differences in access to physicians will help in the design of programs and policies to eliminate them.
Heslin
Kevin C
KC
Research Center in Minority Institutions, Charles R. Drew University of Medicine and Science, Lynwood, CA 90262, USA. keheslin@cdrewu.edu
Andersen
Ronald M
RM
Ettner
Susan L
SL
Cunningham
William E
WE
D001741:Black or African American / Q000706:statistics & numerical data; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000208:ethnology* / Q000628:therapy; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008913:Minority Groups / Q000145:classification / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D012044:Regression Analysis; D014481:United States; D044465:White People / Q000706:statistics & numerical data