title: Patient race/ethnicity and patient-physician race/ethnicity concordance in the management of cardiovascular disease risk factors for patients with diabetes.
abstract: OBJECTIVE Patient-physician race/ethnicity concordance can improve care for minority patients. However, its effect on cardiovascular disease (CVD) care and prevention is unknown. We examined associations of patient race/ethnicity and patient-physician race/ethnicity concordance on CVD risk factor levels and appropriate modification of treatment in response to high risk factor values (treatment intensification) in a large cohort of diabetic patients. RESEARCH DESIGN AND METHODS The study population included 108,555 adult diabetic patients in Kaiser Permanente Northern California in 2005. Probit models assessed the effect of patient race/ethnicity on risk factor control and treatment intensification after adjusting for patient and physician-level characteristics. RESULTS African American patients were less likely than whites to have A1C <8.0% (64 vs. 69%, P < 0.0001), LDL cholesterol <100 mg/dl (40 vs. 47%, P < 0.0001), and systolic blood pressure (SBP) <140 mmHg (70 vs. 78%, P < 0.0001). Hispanic patients were less likely than whites to have A1C <8% (62 vs. 69%, P < 0.0001). African American patients were less likely than whites to have A1C treatment intensification (73 vs. 77%, P < 0.0001; odds ratio [OR] 0.8 [95% CI 0.7-0.9]) but more likely to receive treatment intensification for SBP (78 vs. 71%, P < 0.0001; 1.5 [1.3-1.7]). Hispanic patients were more likely to have LDL cholesterol treatment intensification (47 vs. 45%, P < 0.05; 1.1 [1.0-1.2]). Patient-physician race/ethnicity concordance was not significantly associated with risk factor control or treatment intensification. CONCLUSIONS Patient race/ethnicity is associated with risk factor control and treatment intensification, but patient-physician race/ethnicity concordance was not. Further research should investigate other potential drivers of disparities in CVD care.
authors.affiliation: Goldman School of Public Policy, University of California, Berkeley, California, and the Care Management Institute, Kaiser Permanente, Oakland, California, USA.
authors.forename: Ana H
authors.initials: AH
authors.lastname: Traylor
authors.forename: Usha
authors.initials: U
authors.lastname: Subramanian
authors.forename: Connie S
authors.initials: CS
authors.lastname: Uratsu
authors.forename: Carol M
authors.initials: CM
authors.lastname: Mangione
authors.forename: Joe V
authors.initials: JV
authors.lastname: Selby
authors.forename: Julie A
authors.initials: JA
authors.lastname: Schmittdiel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000209:etiology* / Q000517:prevention & control* / Q000628:therapy; D048909:Diabetes Complications / Q000208:ethnology / Q000517:prevention & control / Q000628:therapy; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000628:therapy*; D004358:Drug Therapy / Q000706:statistics & numerical data; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010361:Patients; D010817:Physician-Patient Relations; D011822:Race Relations; D012307:Risk Factors; D012923:Social Class