Racial and ethnic disparities in medical history taking: detecting substance use among low-income pregnant women.
OBJECTIVE
To determine whether providers' medical history-taking of substance use varies with their patients' race or ethnicity.


METHODS
The medical records of 1083 low-income women who delivered at an urban teaching hospital over a 12-month period were reviewed and data were abstracted. The frequency with which the presence or absence of substance use was documented was compared among Black, Hispanic, and White women. Multivariate models predicting documentation of data on substance use were also built.


RESULTS
Information on substance use was more often documented in the medical records of Black and Hispanic women than in those of White women. For example, 74% of Black women, 78% of Hispanic women, and 60% of White women had data on cocaine use documented in their medical records (P= .0001). Multivariate analyses found that, after controlling for other factors, Black (odds ratio [OR] 4.1) and Hispanic (OR 5.3) non-clinic patients were more likely than White non-clinic patients to have documented data on substance use history in their medical records. No racial/ ethnic disparities were found among clinic patients. Among White women, clinic patients were more likely than non-clinic patients to have documented data on substance use. Among other races and ethnicities, no disparities were found between places of care.


CONCLUSIONS
The differential collection of information on women's medical histories may be influenced by organizational factors and/or provider factors. The standard implementation of history-taking protocols would reduce the influence of institutional and personal biases on the care provided to pregnant women and enable all patients to receive appropriate referrals to treatment.
Kerker
Bonnie D
BD
New York City Department of Health and Mental Hygiene, New York, NY 10013, USA. bkerker@health.nyc.gov
Leventhal
John M
JM
Schlesinger
Mark
M
Horwitz
Sarah M
SM
D000293:Adolescent; D000328:Adult; D003237:Connecticut; D005006:Ethnicity; D005260:Female; D006801:Humans; D008485:Medical Audit; D008487:Medical History Taking / Q000592:standards*; D008499:Medical Records; D011203:Poverty; D011247:Pregnancy; D044469:Racial Groups; D019966:Substance-Related Disorders / Q000175:diagnosis*