The DOI matches its Crossref record; 11 of the 11 references it cites were found in a registry or an index; 4 of the 9 sources its claims cite were checked for support.
Unequal treatment: report of the institute of medicine on racial and ethnic disparities in healthcare
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Written from the paper’s full text.
TL;DR
This symposium paper summarizes the Institute of Medicine's 2002 report *Unequal Treatment*, which concluded that racial and ethnic minorities in the U.S. receive lower-quality healthcare than the majority population across a wide range of conditions and settings, even after adjusting for access, clinical, and socioeconomic factors. It reviews the evidence (with emphasis on cardiovascular care), the committee's framework of contributing factors, and its recommendations for eliminating disparities.
Key findings
- Disparities were found across a wide range of disease areas and clinical services—including cardiac care, cancer screening and treatment, diabetes management, end-stage renal disease, HIV treatment, pediatric care, maternal and child health, mental health, and many surgical procedures—even after correcting for comorbidities, stage of disease, and age.
- In some instances minorities receive more of certain procedures: African Americans underwent bilateral orchiectomy and amputation at rates 2.4 and 3.6 times greater than their white Medicare peers. One study found Latino patients with long bone fractures in Los Angeles emergency rooms received pain medication only half as often as non-Latino patients.
- In cardiovascular care, one analysis of more than 86,000 Medicare patients found whites were nearly four times more likely than African Americans to receive CABG after adjusting for age- and gender-related differences in MI rates; a study of more than 13,000 New Jersey residents found catheterization within 90 days of acute MI was significantly more likely for white patients.
- The committee concluded that bias, stereotyping, prejudice, and clinical uncertainty on the part of providers may contribute to disparities, though the evidence base for these mechanisms is largely indirect; disparities diminish when socioeconomic factors are controlled but do not disappear.
Methods
- The 15-member IOM committee met five times, conducted an extensive literature review (initial search yielded more than 600 citations), and used liaison panels, focus groups, and commissioned papers; it received testimony from educators, accrediting organizations, managed care representatives, medical historians, organized medicine, lawyers, and economists, and information from the military, VA, and federal agencies.
- The committee defined "disparities" as racial or ethnic differences in quality of healthcare not due to access-related factors or clinical needs, preferences, and appropriateness of intervention, and analyzed at two levels: healthcare system operation and the legal/regulatory climate, and individual patient-provider discrimination.
- For cardiovascular evidence specifically, 26 studies met inclusion criteria (published in the past 10 years, peer-reviewed, original findings, meeting established scientific principles); studies focused on health status or access were excluded.
Limitations
- Stated in the paper: no single reviewed study simultaneously controlled for all variables likely to confound the race–care relationship; in almost all articles, disparities diminish once rigorous confounding variables are included in multivariate analysis, though most find significant disparities remain. Large administrative databases (e.g., Medicare) provide little or no information on comorbid illness, disease severity, or stage at detection. The evidence base on bias, stereotyping, and uncertainty is "in large part, indirect."
- Stated in the paper: findings of equal quality were reported in some VA and military populations, and the committee "was not successful in identifying specific factors to account for this fact"; disparities in VA settings were "not consistent."
- Evident from the text: this is a symposium summary of the IOM report rather than new primary research, so its findings rest on the committee's synthesis and the studies it selected; the paper also notes the committee avoided recommending unfunded mandates and was aware of practical difficulties in assuring availability of interpretation and related services.
Model-written summary. Check it against the paper before relying on it.
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Claims the paper makes
18 No basis given · 16 Own interpretation · 6 Own result · 5 No full text of the sources · 3 Not checked yet · 2 Own method · 1 Partly supported · 1 Mixed support · 1 Couldn’t confirm · accuracy not yet measured
Some cited sources support this claim and some don’t — read each source’s verdict below.
In the paper
“the very large national study with patients from the National Registry of Myocardial Infarction 2, comprising 275,000 patients [5], and the prospective controlled studies [6] revealed clear differences in the likelihood of receipt of procedures during nearly every phase of diagnosis and treatment of coronary artery disease, with minority patients usually coming up short.”
§ Unequal Treatment: Report of the Institute of Medicine on Racial and Ethnic Disparities in Healthcare > Evidence in Cardiovascular Disease
What the sources say
- Disputedcites [5] Taylor, 1997, Can characteristics of a health care system mitigate ethnic bias in access to cardiovascular procedures? Experience from the military health services system, J Am Coll Cardiol sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 0 partially supported, 2 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Checked by a reasoning model — may be wrong.
- Partly supportedcites [6] Peterson, 1997, Racial variation in the use of coronary-revascularization procedures, N Engl J Med sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
boostedcorrelationaln = 275,000- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Disputed
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“These differences were not found among white patients similarly deemed appropriate for invasive treatment.”
§ Unequal Treatment: Report of the Institute of Medicine on Racial and Ethnic Disparities in Healthcare > Evidence in Cardiovascular Disease
What the sources say
- Could not verifycites [9] Hemingway, 2001, Underuse of coronary revascularization procedures in patients considered appropriate candidates for revascularization, N Engl J Med sourceExperimental — accuracy not yet measured
The Results identify nonwhite race as a predictor of receiving medical treatment rather than CABG among appropriate candidates. The paper does not report a corresponding analysis showing that the unspecified 'differences' were absent among white patients (searched for white-patient and race-specific comparisons). (LLM, conf=0.75)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“in a prospective study of 2552 patients seen in London hospitals who were deemed appropriate for cardiovascular procedures according to standardized criteria, Hemingway and coworkers [9] found that nonwhite patients were more likely to receive only medical treatment, rather than CABG, after controlling for demographic and clinical variables.”
§ Unequal Treatment: Report of the Institute of Medicine on Racial and Ethnic Disparities in Healthcare > Evidence in Cardiovascular Disease
What the sources say
- Partly supportedcites [9] Hemingway, 2001, Underuse of coronary revascularization procedures in patients considered appropriate candidates for revascularization, N Engl J Med sourceExperimental — accuracy not yet measured
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaincorrelationaln = 2,552- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“the quality of care received by racial and ethnic minorities in this country is generally lower than that provided to the majority population.”
§ Unequal Treatment: Report of the Institute of Medicine on Racial and Ethnic Disparities in Healthcare > Abstract
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“White patients have been found to use some clinical services at higher rates than minorities, even when not necessarily indicated.”
§ Unequal Treatment: Report of the Institute of Medicine on Racial and Ethnic Disparities in Healthcare > Evidence in Cardiovascular Disease
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Disparities were found across a wide range of disease areas and clinical services, even after correcting for clinical factors, such as comorbidities, stage of disease, and age.”
§ Unequal Treatment: Report of the Institute of Medicine on Racial and Ethnic Disparities in Healthcare > Abstract
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The committee found that the evidence for real and significant disparities extends all the way from preventive services on one end of the spectrum to pain relief at the end of life on the other.”
§ Unequal Treatment: Report of the Institute of Medicine on Racial and Ethnic Disparities in Healthcare > Abstract
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Racial and ethnic disparities in health care exist”
§ Unequal Treatment: Report of the Institute of Medicine on Racial and Ethnic Disparities in Healthcare > Evidence in Cardiovascular Disease
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“studies that did not demonstrate disparities were conspicuous by their rarity.”
§ Unequal Treatment: Report of the Institute of Medicine on Racial and Ethnic Disparities in Healthcare > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“in almost all articles, studies that use rigorous measures of potential confounding variables find that disparities diminish once these variables are included in the multivariate analysis.”
§ Unequal Treatment: Report of the Institute of Medicine on Racial and Ethnic Disparities in Healthcare > Evidence in Cardiovascular Disease
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 11
- Probably not a substantial claim. 4
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Several studies find that African-American patients are more likely than whites to refuse invasive procedures, but when the relative contribution of patient refusal to racial differences in care is assessed, this factor is not found to account completely for these disparities.”
§ Unequal Treatment: Report of the Institute of Medicine on Racial and Ethnic Disparities in Healthcare > Evidence in Cardiovascular Disease
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We found that these disparities are associated with socioeconomic differences and diminish when socioeconomic factors are controlled, but they do not disappear.”
§ Unequal Treatment: Report of the Institute of Medicine on Racial and Ethnic Disparities in Healthcare > Evidence in Cardiovascular Disease
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For whites, CABG rates were significantly associated with the availability of thoracic surgeons and location in the Southeast, but physician availability and location were not correlated with CABG rates for African Americans.”
§ Unequal Treatment: Report of the Institute of Medicine on Racial and Ethnic Disparities in Healthcare > Evidence in Cardiovascular Disease
plaincorrelationaln = 86,000- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Black patients were less likely to receive thrombolytic therapy and bypass surgery, even when only high-risk coronary anatomic subgroups were assessed [2]”
§ Unequal Treatment: Report of the Institute of Medicine on Racial and Ethnic Disparities in Healthcare > Evidence in Cardiovascular Disease
What the sources say
- Not checked — no full text of the sourcecites [2] Petersen, 2002, Impact of race on cardiac care and outcomes in veterans with acute myocardial infarction, Med Care source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Disparities are present in cardiac care, cancer screening and treatment, diabetes management, end stage renal disease, treatment of HIV infection, pediatric care, maternal and child health, mental health, rehabilitative and nursing home services, and many surgical procedures.”
§ Unequal Treatment: Report of the Institute of Medicine on Racial and Ethnic Disparities in Healthcare > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“one study indicated that whites were more likely to receive inappropriate angiography, although the racial difference in rates of inappropriate percutaneous transluminal coronary angioplasty was not sufficiently large to account for more than a small fraction of the substantial disparities in rates of revascularization between white patients and African-American patients [7].”
§ Unequal Treatment: Report of the Institute of Medicine on Racial and Ethnic Disparities in Healthcare > Evidence in Cardiovascular Disease
What the sources say
- Not checked — no full text of the sourcecites [7] Schneider, 2001, Racial differences in cardiac revascularization rates. Does “overuse” explain higher rates among white patients?, Ann Intern Med source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“in one study, although cardiac catheterization was performed less often in nonwhites when compared with whites, angioplasty and bypass grafting were received equally often in white and nonwhite patients among those catheterized who had indications for revascularization [8].”
§ Unequal Treatment: Report of the Institute of Medicine on Racial and Ethnic Disparities in Healthcare > Evidence in Cardiovascular Disease
What the sources say
- Not checked — no full text of the sourcecites [8] Scirica, 1999, Racial differences in the management of unstable angina, Am Heart J source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Racial and ethnic disparities in services are found among patients insured by Medicare and among patients in VA settings, although these findings are not consistent.”
§ Unequal Treatment: Report of the Institute of Medicine on Racial and Ethnic Disparities in Healthcare > Evidence in Cardiovascular Disease
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“These studies, however, find that differences in refusal rates are generally small and that minority patient refusal does not fully explain healthcare disparities.”
§ Unequal Treatment: Report of the Institute of Medicine on Racial and Ethnic Disparities in Healthcare > Evidence in Cardiovascular Disease
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“there is no evidence to suggest that providers are more likely than the general public to express biases, and some evidence suggests that unconscious biases may exist.”
§ Unequal Treatment: Report of the Institute of Medicine on Racial and Ethnic Disparities in Healthcare > Evidence in Cardiovascular Disease
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Racial and ethnic disparities in health care occur in the context of broader historic and contemporary social and economic inequality, and evidence of persistent racial and ethnic discrimination in many sectors of American life.”
§ Unequal Treatment: Report of the Institute of Medicine on Racial and Ethnic Disparities in Healthcare > Evidence in Cardiovascular Disease
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It also can influence how information is processed and recalled.”
§ Unequal Treatment: Report of the Institute of Medicine on Racial and Ethnic Disparities in Healthcare > Evidence in Cardiovascular Disease
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“our society still reflects attitudes and behaviors that can fairly be called discriminatory”
§ Unequal Treatment: Report of the Institute of Medicine on Racial and Ethnic Disparities in Healthcare > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although disparities in the quality of care may be reflective of inequalities in other aspects of American life, such as housing, jobs, and education”
§ Unequal Treatment: Report of the Institute of Medicine on Racial and Ethnic Disparities in Healthcare > Conclusions
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
The paper relies on this without support.
The existence of racial and ethnic disparities in health care is still largely unrecognized.
“the committee believes that the existence of disparities is still largely unrecognized”
The paper relies on this without support.
Public and professional awareness is an essential starting point for efforts at reduction of disparities.
“public and professional awareness is an essential starting point for efforts at reduction”
The paper relies on this without support.
Beneficence, as an element of professionalism, is supposed to be color blind.
“beneficence, as an element of professionalism, is supposed to be color blind.”
The paper relies on this without support.
Racial and ethnic disparities in health care are unacceptable.
“they are unacceptable”
Citations
Cites
Unequal treatment: confronting racial and ethnic disparities in health care
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Self-citationUnequal treatment: confronting racial and ethnic disparities in health care.
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Impact of Race on Cardiac Care and Outcomes in Veterans With Acute Myocardial Infarction
Petersen, L. A., Wright, S. M., Peterson, E. D., & Daley, J. (2002) · Medical Care · doi:10.1097/00005650-200201001-00010 · Cited by 146
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Scirica, B. M., Moliterno, D. J., Every, N. R., Anderson, H. V., Aguirre, F. V., Granger, C. B., Lambrew, C. T., Rabbani, L. E., Sapp, S. K., Booth, J. E., et al. (1999) · American Heart Journal · doi:10.1016/s0002-8703(99)70071-2 · Cited by 36
Equity in the Diagnosis of Chest Pain: Race and Gender
Bell, P. D., & Hudson, S. (2001) · American Journal of Health Behavior · doi:10.5993/ajhb.25.1.7 · Cited by 29
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“social constructs, thus healthcare disparities are likely mediated through various socioeconomic factors rather than through biological differences between groups.(10) Few studies have assessed the role of socioeconomic factors as primary predictors of outcome, such as parental education levels, insurance status, and…”
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“monitoring of progress toward the elimination of health care disparities [29, 30].”
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“Patients had to fulfill the following criteria for eligibility: (1) age 18 years, (2) elevated troponin level (cardiac enzyme elevation as a complication of elective coronary revascularization did not qualify), (3) clinical features of ischemia (eg, prolonged ischemic signs/symptoms, ECG ST changes in 2 consecutive le…”
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Singh, T. P., Almond, C. S. D., Givertz, M. M., Piercey, G. E., & Gauvreau, K. (2011) · Circulation Heart Failure · doi:10.1161/circheartfailure.110.957829 · Cited by 85
“Unknown 11 644 (39) 1356 (29) 613 (30) 13 613 (37)”
Sabo, S. J., Ingram, M., Reinschmidt, K. M., Schachter, K. A., Jacobs, L. E., de Zapien, J. G., Robinson, L., & Carvajal, S. C. (2013) · American Journal of Public Health · doi:10.2105/ajph.2012.301108 · Cited by 79
Racial and regional disparities in lung cancer incidence
Underwood, J. M., Townsend, J. S., Tai, E. W., Davis, S. P., Stewart, S. L., White, A. L., Momin, B. R., & Fairley, T. L. (2011) · Cancer · doi:10.1002/cncr.26479 · Cited by 78
Mental Illness and the Criminal Justice System
Hiday, V. A., & Burns, P. J. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511984945.029 · Cited by 79
Physical Therapists’ Management of Patients in the Acute Care Setting: An Observational Study
Jette, D. U., Brown, R. J., Collette, N., Friant, W., & Graves, L. (2009) · Physical Therapy · doi:10.2522/ptj.20080338 · Cited by 75
Psychological Approaches to Mental Illness
Peterson, C. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511984945.008 · Cited by 77
Poverty, insurance, and region as predictors of epilepsy treatment among US adults
Szaflarski, M., Wolfe, J. D., Tobias, J. G. S., Mohamed, I., & Szaflarski, J. P. (2020) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2020.107050 · Cited by 63
“Epilepsy is more prevalent among minorities [5, 43], and disparities in health care by race/ethnicity and immigrant status are pervasive [7, 44].”
BackgroundMethodInsurance Coverage and Care of Patients with Non–ST-Segment Elevation Acute Coronary Syndromes
Calvin, J. E., Roe, M. T., Chen, A. Y., et al. (2006) · Annals of Internal Medicine · doi:10.7326/0003-4819-145-10-200611210-00006 · Cited by 62
“Our findings and those of previous studies indicate that restructuring the Medicaid infrastructure and financing may be needed to promote better quality of care (22).”
ResultRacial and Socioeconomic Disparity in Perforated Appendicitis Among Children: Where Is the Problem?
Nwomeh, B. C., Chisolm, D. J., Caniano, D. A., & Kelleher, K. J. (2006) · PEDIATRICS · doi:10.1542/peds.2005-1123 · Cited by 62
Disparities Exist in the Emergency Department Evaluation of Pediatric Chest Pain
Hambrook, J. T., Kimball, T. R., Khoury, P. R., et al. (2010) · Congenital Heart Disease · doi:10.1111/j.1747-0803.2010.00414.x · Cited by 61
Well-Being across the Life Course
Mirowsky, J., & Ross, C. E. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511984945.023 · Cited by 60
Persisting Racial Disparities in Total Shoulder Arthroplasty Utilization and Outcomes
Singh, J. A., & Ramachandran, R. (2015) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-015-0138-3 · Cited by 56
“The Institute of Medicine recommends that after detection and descriptions of disparities, monitoring progress toward the elimination of health care disparities is needed [39, 40].”
BackgroundMarital Status and Mental Health
Williams, K., Frech, A., & Carlson, D. L. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511984945.020 · Cited by 70
Medical students’ attitudes toward gay men
Matharu, K., Kravitz, R. L., McMahon, G. T., Wilson, M., & Fitzgerald, F. T. (2012) · BMC Medical Education · doi:10.1186/1472-6920-12-71 · Cited by 58
“Background Though medical care in the United States has promoted health and longevity, many disparities persist even after socioeconomic status and other factors have been accounted for [1,2].”
BackgroundSources and Barriers to Health Care Coverage for Haitian Immigrants in Miami-Dade County, Florida
Saint‐Jean, G., & Crandall, L. A. (2005) · Journal of Health Care for the Poor and Underserved · doi:10.1353/hpu.2005.0016 · Cited by 51
Rogers, C. R., Rogers, T. N., Matthews, P., Duc, N. L., Zickmund, S. L., Powell, W., Thorpe, R. J., McKoy, A., Davis, F. A., Okuyemi, K. S., et al. (2020) · Ethnicity and Health · doi:10.1080/13557858.2020.1849569 · Cited by 48
“The Institute of Medicine’s Unequal Treatment (2003) report documented that African Americans and other racial and ethnic minorities often received lower-quality health care even when they had the same levels of health insurance coverage and income as their white counterparts (Nelson 2003).”
BackgroundBarratt, J., Khoza‐Shangase, K., & Msimang, K. (2012) · South African Journal of Communication Disorders · doi:10.4102/sajcd.v59i1.20 · Cited by 45
Singh, T. P., Almond, C. S. D., Taylor, D. O., et al. (2012) · Circulation · doi:10.1161/circulationaha.112.092643 · Cited by 42
“The specific objectives of this study were (1) to compare baseline characteristics between white, black, and Hispanic patients listed for a HT in the United States, (2) to compare wait-list mortality between these racial/ethnic groups, and (3) to compare early posttransplant mortality between HT recipients in the 3 gr…”
BackgroundMethodVanderbilt, A. A., Dail, M., & Jaberi, P. (2015) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s74129 · Cited by 41
A Handbook for the Study of Mental Health
(2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289 · Cited by 43
Outcomes of a Breast Health Project for Hmong Women and Men in California
Kagawa‐Singer, M., Tanjasiri, S. P., Valdez, A., et al. (2009) · American Journal of Public Health · doi:10.2105/ajph.2008.143974 · Cited by 37
“Such social and cultural variations highlight the barriers faced by Hmong women to access and use of breast cancer screening services and underscore the need for culturally congruent approaches to increase cancer screening services through established strategies such as community-based outreach and lay health worker p…”
BackgroundHorwitz, A. V. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511984945.004 · Cited by 40
Analysis of Race and Ethnicity, Socioeconomic Factors, and Tooth Decay Among US Children
Choi, S. E., White, J. M., Mertz, E., & Normand, S. T. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.18425 · Cited by 39
Race and Socioeconomic Bias in Pediatric Cardiac Transplantation
Amdani, S. M., Conway, J. L., Kleinmahon, J. A., et al. (2022) · JACC Heart Failure · doi:10.1016/j.jchf.2022.08.021 · Cited by 33
Women's Expectation of Receiving Reproductive Health Care at Catholic and Non‐Catholic Hospitals
Stulberg, D. B., Guiahi, M., Hebert, L. E., et al. (2019) · Perspectives on Sexual and Reproductive Health · doi:10.1363/psrh.12118 · Cited by 30
Fyffe, D. C., Deutsch, A. F., Botticello, A., Kirshblum, S., & Ottenbacher, K. J. (2014) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2014.07.398 · Cited by 30
Singh, T. P., Gauvreau, K., Thiagarajan, R. R., Blume, E. D., Piercey, G. E., & Almond, C. S. D. (2009) · American Journal of Transplantation · doi:10.1111/j.1600-6143.2009.02852.x · Cited by 30
“The Institute of Medicine has defined ‘disparities’ in health care as racial or ethnic differences in the quality of health care that are not due to access related factors or clinical needs, preferences or appropriateness of intervention (18,19).”
BackgroundWork and Unemployment as Stressors
Lennon, M. C., & Limonic, L. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511984945.015 · Cited by 46
McQuillan, J., Andersen, J. A., Berdahl, T. A., & Willett, J. (2021) · Arthritis Care & Research · doi:10.1002/acr.24730 · Cited by 29
“The current study is guided by the social determinants of health (20), biopsychosocial model of health (21), and health disparities (14,22,23) frameworks and answers the following questions: 1) Are within-person changes in RA illness (i.”
BackgroundMethodCurricular integration of social medicine: a prospective for medical educators
Vanderbilt, A. A., Baugh, R. F., Hogue, P., et al. (2016) · Medical Education Online · doi:10.3402/meo.v21.30586 · Cited by 28
Seneviratne, S. A., Campbell, I. D., Scott, N., et al. (2014) · BMC Cancer · doi:10.1186/1471-2407-14-839 · Cited by 27
“Delays in cancer adjuvant therapy are associated with factors including lack of access to healthcare, difficulties with navigating the health system, geographic distance to treatment facility, availability of transport and ability to take time-off work to attend adjuvant therapy [1,27,28].”
BackgroundSingh, T. P., Almond, C. S. D., & Gauvreau, K. (2010) · American Journal of Transplantation · doi:10.1111/j.1600-6143.2010.03357.x · Cited by 25
“Reduction and elimination of disparities in health care and health outcomes is a national priority in the United States (33).”
BackgroundInfluentialA Model Partnership: Mentoring Underrepresented Students in Medicine (URiM) in Emergency Medicine
Goines, J. B., Iledare, E., Ander, D. S., et al. (2021) · Western Journal of Emergency Medicine · doi:10.5811/westjem.2020.9.48923 · Cited by 23
Studying Stress in the Twenty-First-Century: An Update of Stress Concepts and Research
Wheaton, B., & Montazer, S. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.013 · Cited by 24
MacDonald, D. J., Sarna, L. P., Giger, J. N., et al. (2008) · Journal of Health Communication · doi:10.1080/10810730802198920 · Cited by 21
Dentists' perceptions of providing care in long-term care facilities.
Chowdhry, N., Aleksejūnienė, J., Wyatt, C. C. L., et al. (2011) · PubMed · Cited by 20
Velázquez, A. I., Gilligan, T. D., Kiel, L., Graff, J. N., & Duma, N. (2022) · American Society of Clinical Oncology Educational Book · doi:10.1200/edbk_350691 · Cited by 20
Chakraborty, S., Bandyopadhyay, D., Amgai, B., et al. (2019) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2019.02.003 · Cited by 19
The Dual Continua Model: The Foundation of the Sociology of Mental Health and Mental Illness
Keyes, C. L. M. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.007 · Cited by 22
Ameratunga, S. N., Abel, S. L., Tin, S. T., et al. (2010) · BMC Health Services Research · doi:10.1186/1472-6963-10-333 · Cited by 18
“The key informant Māori and Pacific support workers in the present study were aware of the significant stresses experienced by families of Māori and Pacific children who are known to experience a disproportionately high rate of unintentional injury [16-18].”
BackgroundJohnson, R. J., & Hobfoll, S. E. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511984945.024 · Cited by 17
Addressing Implicit Bias to Improve Cross-cultural Care
PEREDA, B., & Montoya, M. E. (2018) · Clinical Obstetrics & Gynecology · doi:10.1097/grf.0000000000000341 · Cited by 16
“Our Approach We believe that academic health centers and departments can develop more inclusive learning and work environments by (1) being empowered by the academic leadership, (2) cultivating a team of experienced consultant trainers, preferably including other disciplines, (3) developing race-conscious curricula, a…”
BackgroundMeyers, K. A., Price, D. M., & Golub, S. A. (2019) · Current Opinion in HIV and AIDS · doi:10.1097/coh.0000000000000596 · Cited by 16
Socioeconomic Stratification and Mental Disorder
Eaton, W. W., & Muntaner, C. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.016 · Cited by 18
The Measurement of Mental Disorder
Wakefield, J. C., & Schmitz, M. F. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511984945.005 · Cited by 20
Understanding the Connection between Social Support and Mental Health
Brown, R. L., & Ciciurkaite, G. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.014 · Cited by 15
Elk, R. A. (2021) · Cancer · doi:10.1002/cncr.33627 · Cited by 14
“The consequences of implicit bias by clinicians and others in the health care system were noted in the Institute of Medicine report Unequal Treatment.19 A more recent study found that there were clinician- based factors in the receipt of unequal care; clinicians who were less culturally competent and who held unconsci…”
BackgroundKeith, V. M., & Brown, D. R. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511984945.019 · Cited by 17
Simon, M. A., Fitzgibbon, M., Ciecierski, C. C., Cooper, J. M., Martinez, E., Tom, L. S., Kanoon, J. M., Feinglass, J. M., Warnecke, R. B., Stuart, M. E., et al. (2019) · Progress in community health partnerships · doi:10.1353/cpr.2019.0030 · Cited by 13
Barratt, J., Khoza‐Shangase, K., & Msimang, K. (2012) · South African Journal of Communication Disorders · doi:10.7196/sajcd.51 · Cited by 13
Mwachofi, A. (2008) · The Journal of Negro Education · Cited by 13
Gender and Racial Representation Trends Among Internal Medicine Department Chairs from 2010–2020
Samuel, A., Cervero, R. M., & Durning, S. J. (2022) · Journal of General Internal Medicine · doi:10.1007/s11606-022-07783-z · Cited by 12
“Quality medical education, reduction in health disparities, and healthcare research that includes all members of society are enhanced by diversity in departments of internal medicine (IM).(1,2,3,4) As the largest subspecialty in medicine, IM trains the largest number of medical students and postgraduate trainees and p…”
BackgroundSmith, M. A., Gigot, M., Harburn, A., Bednarz, L., Curtis, K., Mathew, J., & Farrar‐Edwards, D. (2023) · Journal of Clinical and Translational Science · doi:10.1017/cts.2022.521 · Cited by 9
“experience substantial gaps in the quality of healthcare [15].”
BackgroundSmith, V. C., & Jemal, A. (2015) · Health Promotion Practice · doi:10.1177/1524839915588293 · Cited by 11
“…racial/ethnic groups (Agency for Healthcare Research and Quality, 2011; Institute of Medicine, 2002; Jackson, Knight, & Rafferty, 2010; Keppel, Pearcy, & Wagener, 2002; National Center for Health Statistics, Centers for Disease Control and Prevention, 2001; Nelson, 2002; Smedley, 588293HPPXXX10.”
BackgroundEffect of interventions to improve health care services for ethnic minority populations
Forsetlund, L., Eike, M. C., & Vist, G. E. (2011) · Norsk Epidemiologi · doi:10.5324/nje.v20i1.1294 · Cited by 9
“A review performed by the American Institute of Medicine in 2002 found that there were disparities in treatment of minority and majority population in almost all clinical areas, from early preventive interventions to treatment of pain, which could not be attributed to differences in insurance status, income, age or se…”
MethodLink, B. G., & Phelan, J. C. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.024 · Cited by 11
Rosenfield, S., Kato, K., & Smith, D. T. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.017 · Cited by 9
Black–White disparities across the colorectal cancer care continuum in the USA
May, F. P., Mehtsun, W. T., Jemal, A., & Gupta, S. N. (2025) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-025-01087-3 · Cited by 9
“…in receipt of guideline-concordant treatment are well described and are the consequence of adverse SDOH, including generational differences in wealth, disparities in health-care access, systemic bias within health-care systems, and medical mistrust due to entrenched structural racism 16,136,137 .”
Horwitz, A. V. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.004 · Cited by 8
County-Level Assessment of Vulnerability to COVID-19 in Alabama
Fall, S., Abdalla, E., Quansah, J. E., et al. (2022) · ISPRS International Journal of Geo-Information · doi:10.3390/ijgi11050320 · Cited by 8
Kumar, N., & Jain, G. (2023) · Journal of Science and Technology Policy Management · doi:10.1108/jstpm-09-2022-0147 · Cited by 8
Integrating Service Delivery Systems for Persons with a Severe Mental Illness
Cuddeback, G. S., & MORRISSEY, J. P. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511984945.031 · Cited by 9
Well-Being across the Life Course
Mirowsky, J., & Ross, C. E. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.021 · Cited by 8
Evaluation of a Telehealth Counseling Program for Expatriates
Park, H. Y., Kim, J. Y., Koo, H. Y., et al. (2018) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2018.0082 · Cited by 7
“Clear communication between healthcare providers and patients is essential because it impacts patient satisfaction, adherence to recommendations, and health outcomes,(20) and these are influenced by language differences.(16,17) Another factor might be a patient’s trust in the doctor.”
BackgroundRacial/Ethnic Disparities in Health Care Access Are Associated with Adverse Childhood Experiences
Srivastav, A., Richard, C. L., Kipp, C., Strompolis, M., & White, K. (2020) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-020-00747-1 · Cited by 7
Blitz, J. D., Swisher, J., & Sweitzer, B. (2020) · Anesthesiology Clinics · doi:10.1016/j.anclin.2020.01.005 · Cited by 7
Defining Mental Disorders: Sociological Investigations into the Classification of Mental Disorders
Whooley, O. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.006 · Cited by 7
Disparities and Inequities Among Patients with Central Nervous System Tumor
Chukwueke, U. N., Hervey‐Jumper, S. L., & Porter, A. B. (2021) · Hematology/Oncology Clinics of North America · doi:10.1016/j.hoc.2021.10.002 · Cited by 7
Keith, V. M., & Brown, D. R. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.019 · Cited by 9
Underserved Elderly Issues in the United States: Burdens of Oral and Medical Health Care
Greene, V. (2005) · Dental Clinics of North America · doi:10.1016/j.cden.2004.11.001 · Cited by 7
“Nonetheless, health care among older underrepresented racial and ethnic populations still differs from that of the majority population, and these disparities have not been explained by factors such as access, insurance status, needs or preferences, or type of interventions or services [5,9].”
BackgroundInfluentialWhy every anesthesia trainee should receive global health equity education
Wollner, E., Law, T. J., Sullivan, K. R., & Lipnick, M. S. (2020) · Canadian Journal of Anesthesia/Journal canadien d anesthésie · doi:10.1007/s12630-020-01715-3 · Cited by 7
The Measurement of Mental Disorder
Wakefield, J. C., & Schmitz, M. F. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.005 · Cited by 7
Health Disparities and Inequities in Epilepsy
Correa, D. J., & Gutierrez, C. (2024) · Springer eBooks · doi:10.1007/978-3-031-62727-9_5 · Cited by 5
A call to action following the US Supreme Court affirmative action ruling
Pereira, R. I., Diaz-Thomas, A., Hinton, A. O., Jr., et al. (2023) · The Lancet · doi:10.1016/s0140-6736(23)02700-9 · Cited by 5
Is Minority Status a More Consistent Predictor of Disability Than Socioeconomic Status?
Mwachofi, A., & Broyles, R. H. (2008) · Journal of Disability Policy Studies · doi:10.1177/1044207308315275 · Cited by 5
“Among those aged 55 to 65 years, the proportions with severe disabilities were 20% among Whites and 35% among African Americans (Nelson, 2003).”
BackgroundExploring and Reducing the Impact of Neighborhoods on Health Disparities
Jackson, J. L., & Williams, J. S. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.10206 · Cited by 4
Rural access to vocational rehabilitation services: Minority farmers' perspective
Mwachofi, A. (2007) · Disability and Rehabilitation · doi:10.1080/09638280701240409 · Cited by 4
“There are disparities throughout the spectrum of healthcare from preventive services to pain relief at the end of life [6].”
BackgroundMoazzami, K., Young, A., Sullivan, S. M., Kim, J. H., Garcia, M. C., Johnson, D. A., Lewis, T. T., Shah, A. J., Bremner, J. D., Quyyumi, A. A., et al. (2020) · Sleep Health · doi:10.1016/j.sleh.2020.07.004 · Cited by 4
Addressing pediatric surgical health inequities through quality improvement efforts
Smith, C. J., Raval, M. V., Simon, M. A., & Henry, M. C. W. (2023) · Seminars in Pediatric Surgery · doi:10.1016/j.sempedsurg.2023.151280 · Cited by 4
Williams, D. R., Costa, M., & Leavell, J. P. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.018 · Cited by 4
Work and Unemployment as Stressors
Limonic, L., & Lennon, M. C. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.015 · Cited by 4
Johnson, R. J., Hobfoll, S. E., & Beulaygue, I. C. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.022 · Cited by 5
Cultural Diversity and Mental Health Treatment
Woo, B., Walton, E. C., & Takeuchi, D. T. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.029 · Cited by 4
Cultural Sensitivity and Global Pharmacy Engagement in the United States
Alsharif, N. Z., Khanfar, N. M., Brennan, L., et al. (2019) · American Journal of Pharmaceutical Education · doi:10.5688/ajpe7220 · Cited by 3
“In fact, the concept of diversity and inclusion has been increasingly emphasized in the United States, along with an effort to have a health care force that is culturally representative of the population it serves.(72) Regulation plays a major role in the health care industry and insurance coverage.”
Background
Metadata
- Authors
- Nelson, A. R.
- Corresponding author
- Nelson, Alan R
- Venue
- The Annals of Thoracic Surgery
- Publisher
- Elsevier BV
- Published
- 2003-10
- Volume
- 76
- Issue
- 4
- Pages
- S1377-S1381
- ISSN
- 0003-4975 (ISSN-L)
- OpenAlex
- W2076125949
- Semantic Scholar
- a6d0d05a68cdad492c945f2a9f5f62840ec8c6f9
- Cited by
- 166
- References
- 10
- Citations by year
- 2026: 1 · 2025: 9 · 2024: 7 · 2023: 11 · 2022: 6 · 2021: 7 · 2020: 9 · 2019: 6 · 2018: 5 · 2017: 36 · 2016: 2 · 2015: 5 · 2014: 6 · 2013: 3 · 2012: 11
- FWCI
- 2.72
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Annals of Thoracic Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Cultural Competency in Health Care
- Social Sciences › Anthropology › Race, Genetics, and Society
- Keywords
- racial and ethnic disparities, health care disparities, Institute of Medicine report, quality of care, racial minorities, health equity
- MeSH terms
- Black or African American, Cardiology, Ethnicity, Health Services Accessibility, Humans, Minority Groups, Prejudice, United States, Racial Groups
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