title: Race/ethnicity, and Americans' perceptions and experiences of over- and under-use of care: a cross-sectional study.
abstract: BACKGROUND
  Despite widespread documentation of racial/ethnic disparities in care (predominantly under-use of needed care), differences in population-wide attitudes or experiences about under- or overuse (care where harms may outweigh potential benefits) of care are not well understood. We examined whether race/ethnicity is associated with perceptions or experiences of overuse or underuse.
  
  
  METHODS
  We conducted secondary analysis of a cross-sectional national telephone survey of nationally representative sample of 1238 American adults; 57.9 % female, 75.4 % Non-Hispanic White, 11.8 % Non-Hispanic Black, 10.1 % Hispanic. The main outcome measures are general perceptions and personal experiences of overuse and underuse, including cost-related dimensions of each.
  
  
  RESULTS
  Bivariate results indicated that respondents of minority race/ethnicity generally viewed both overuse and underuse as bigger problems than did Whites, and reported more personal experiences of each. After adjustment, Hispanics were less likely than Whites to report personal experiences of overuse (odds ratio [OR] [95 % CI], 0.44 [0.23 to 0.86]), while Blacks and Others were more likely to report cost-related overuse (ORs [95 % CIs], 4.16 [2.30 to 7.51]; 3.55 [1.52 to 8.28], respectively). Non-Hispanic Others more often reported doctors' protection from overuse (OR [95 % CI], 3.69 [1.75 to 7.78]). General concerns with underuse were more frequent among Blacks and Hispanics (ORs [95 % CIs], 3.07 [1.72 to 5.54]; 2.12 [1.24 to 3.61] respectively), while Others reported significantly fewer concerns (OR [95 % CI], 0.43 [0.23 to 0.80]).
  
  
  CONCLUSIONS
  Over- and underuse of medical care are important problems for many Americans, and experiences vary by race/ethnicity. Clinician communication and educational campaigns about appropriateness of care may need tailoring for varying population groups.
authors.affiliation: Section of General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Centre, Boston, MA, 02118, USA. nkressin@bu.edu.|VA Boston Healthcare System, Boston, MA, 02130, USA. nkressin@bu.edu.
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Kressin
authors.affiliation: Section of General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Centre, Boston, MA, 02118, USA. mylin@bu.edu.|Health Policy and Management Department, Boston University School of Public Health, Boston, MA, 02118, USA. mylin@bu.edu.
authors.forename: Meng-Yun
authors.initials: MY
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D000069342:Medical Overuse / Q000706:statistics & numerical data; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D010465:Perception; D011795:Surveys and Questionnaires; D014481:United States / Q000208:ethnology; D044465:White People / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult