Journal of General Internal Medicine

, Volume 16, Issue 4, pp 276–280

Disparities in health and health care

Moving from describing the problem to a call for action
  • Carol M. Mangione
  • Eileen Reynolds


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  1. 1.
    Kirschstein RL, Ruffin J. Strategic research plan to reduce and ultimately eliminate health disparities, National Institutes of Health, U.S. Department of Health and Human Services, Oct 2000.Google Scholar
  2. 2.
    Ware JE, Rogers WH, Davies AR, et al. Comparison of health outcomes at a health maintenance organization with those of feefor-service care. Lancet. 1986;May 3:1017–22.CrossRefGoogle Scholar
  3. 3.
    Cunningham WE, Hays RD, Williams KW, Beck KC, Dixon WJ, Shapiro MF. Access to medical care and health-related quality of life for low-income persons with symptomatic human immunodeficiency virus. Medical Care. 1995;33:739–54.PubMedCrossRefGoogle Scholar
  4. 4.
    Cooper R, Cutler J, Desvigne-Nickens P, et al. Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States: findings of the national conference on cardiovascular disease prevention. Circulation. (Online) 2000;102:3137–47.Google Scholar
  5. 5.
    Gordon HS, Harper DL, Rosenthal GE. Racial variation in predicted and observed in-hospital death: a regional analysis. JAMA. 1996;276:1639–44.CrossRefPubMedGoogle Scholar
  6. 6.
    Kahn KL, Pearson ML, Harrison ER, et al. Health care for black and the poor hospitalized Medicare patients. JAMA. 1994;271:1169–74.CrossRefPubMedGoogle Scholar
  7. 7.
    Udvarhelyi IS, Gatsonis C, Epstein AM, Pashos CI, Newhouse JP, McNeil BJ. Acute myocardial infarction in the Medicare population. Process of care and clinical outcomes. JAMA. 1992;268:2530–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Peterson ED, Wright SM, Daley J, Thibault GE. Racial variation in cardiac procedure use and survival following acute myocardial infarction in the Department of Veterans Affairs. JAMA. 1994;271:1175–80.CrossRefPubMedGoogle Scholar
  9. 9.
    Cooper GS, Yuan Z, Landefeld CS, Rimm AA. Surgery for colorectal cancer: race-related differences in rates and survival among Medicare beneficiaries. Am J Public Health. 1996;86(4):582–6.PubMedGoogle Scholar
  10. 10.
    Bach PB, Cramer LD, Warren JL, Begg CB. Racial differences in the treatment of early-stage lung cancer. N Engl J Med. 1999;341:1198–205.CrossRefPubMedGoogle Scholar
  11. 11.
    Ayanian JZ, Epstein AM. Differences in the use of procedures between women and men hospitalized for coronary artery disease. N Engl J Med. 1991;325:221–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Krumholz HM, Douglas PS, Lauer MS, Pasternak RC. Selection of patients for coronary angiography and coronary revascularization early after myocardial infarction: is there evidence for gender bias? Ann Intern Med. 1992;116:785–90.PubMedGoogle Scholar
  13. 13.
    Ayanian JZ, Udvarhelyi IS, Gatsonis CA, Pashos CL, Epstein AM. Racial differences in the use of revascularization procedures after coronary angiography. JAMA. 1993;269:2642–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Whittle J, Congliaro J, Good CB, Lofgren RP. Racial differences in the use of invasive cardiovascular procedures in the Department of Veteran’s Affairs medical system. N Engl J Med. 1993;329:621–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Carlisle DM, Leake BD, Shapiro MF. Racial and ethnic disparities in the use of cardiovascular procedures: associations with type of insurance. Am J Public Health. 1997;87:263–7.PubMedGoogle Scholar
  16. 16.
    Makuc DM, Breen N, Freid V. Low income, race, and the use of mammography. Health Serv Res. 1999;34(1 Pt 2):229–39.PubMedGoogle Scholar
  17. 17.
    Hayward RA, Shapiro MF, Freeman HE, Corey CR. Who gets screened for cervical and breast cancer? Results from a new national survey. Arch Intern Med. 1988;148:1177–81.CrossRefPubMedGoogle Scholar
  18. 18.
    Johnson PA, Lee TH, Cook EF, Rouan GW, Goldman L. Effect of race on the presentation and management of patients with acute chest pain. Ann Intern Med. 1993;118:593–601.PubMedGoogle Scholar
  19. 19.
    Murray-Garcia JL, Selby JV, Schmittdiel J, Grumbach K, Quesenberry CP. Racial and ethnic differences in a patient survey: patients’ values, ratings, and reports regarding physician primary care performance in a large health maintenance organization. Med Care. 2000;38:300–10.CrossRefPubMedGoogle Scholar
  20. 20.
    Taira DA, Safran DG, Seto TB, et al. Asian-American patient ratings of physician primary care performance. J Gen Intern Med. 1997;12:237–42.PubMedCrossRefGoogle Scholar
  21. 21.
    Escarce JJ, Epstein KR, Colby DC, Schwartz JS. Racial differences in the elderly’s use of medical procedures and diagnostic tests. Am J Public Health. 1993;340:618–26.Google Scholar
  22. 22.
    Retchin SM, Brown B. The quality of ambulatory care in Medicare health maintenance organizations. J Public Health. 1990;80:411–5.Google Scholar
  23. 23.
    Retchin SM, Clement DG, Rossiter LF, Brown B, Brown R, Nelson L. How the elderly fare in HMOs: outcomes from the medicare competition demonstrations. Health Serv Res. 1992;27:651–68.PubMedGoogle Scholar
  24. 24.
    Clement DG, Retchin SM, Brown RS, Stegall MH. Access and outcomes of elderly patients enrolled in managed care. JAMA. 1994;271:1487–92.CrossRefPubMedGoogle Scholar
  25. 25.
    Kass BL, Weinick MN, Monheit AC. Racial and ethnic differences in health, 1996. Agency for Health Care Policy and Research, 1999. MEPS Chartbook No. 2. AHCPR Pub. No. 99-0001.Google Scholar
  26. 26.
    Iezzoni LI, McCarthy EP, Davis RB, Siebens H. Mobility difficulties are not only a problem of old age. J Gen Intern Med. 2001;16:235–43.CrossRefPubMedGoogle Scholar
  27. 27.
    Barsky AJ, Peekna HM, Borus JF. Somatic symptom reporting in women and men. J Gen Intern Med. 2001;16:266–75.CrossRefPubMedGoogle Scholar
  28. 28.
    Derose KP, Hays RD, McCaffrey DF, Baker DW. Does physician gender affect satisfaction of men and women visiting the emergency department? J Gen Intern Med. 2001;16:218–26.CrossRefPubMedGoogle Scholar
  29. 29.
    Weisse CS, Sorum PC, Sanders KN, Syat BL. Do gender and race affect decisions about pain management? J Gen Intern Med 2001;16:211–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Wigton RS, McGaghie WC. The effect of obesity on medical students’ approach to patients with abdominal pain. J Gen Intern Med 2001;16:262–5.CrossRefPubMedGoogle Scholar
  31. 31.
    Watson RE, Stein AD, Dwamena FC, et al. Do race and gender influence the use of invasive procedures? J Gen Intern Med. 2001;16:227–34.CrossRefPubMedGoogle Scholar
  32. 32.
    Manning WG, Newhouse JP, Duan N, et al. Health insurance and the demand for medical care. Am Econ Rev. 1987;77:251–77.PubMedGoogle Scholar
  33. 33.
    Brook RH, Ware JE, Rogers WH, et al. Does free care improve adults’ health? N Engl J Med. 1983;309:1426–34.PubMedCrossRefGoogle Scholar
  34. 34.
    Lurie N, Kamberg CJ, Brook RH, Keeler EB, Newhouse JP. How free care improved vision in the Health Insurance Experiment. Am J Public Health. 1989;79:640–2.PubMedGoogle Scholar
  35. 35.
    Miller RH, Luft HS. Managed care plan performance since 1980. JAMA. 1994;271:1512–9.CrossRefPubMedGoogle Scholar
  36. 36.
    Johnson AN, Dowd B, Morris NE, Lurie N. Differences in patient resource use by type of health plan. Inquiry. 1989;26:388–98.PubMedGoogle Scholar
  37. 37.
    Wells KB, Hays RD, Burnam MA, Rogers W, Greenfield S, Ware JE Jr. Detection of depressive disorder for patients receiving prepaid or fee-for-service care: results from the Medical Outcomes Study. JAMA. 1989;262:3298–302.CrossRefPubMedGoogle Scholar
  38. 38.
    Rogers WH, Wells KB, Meredith LS, Sturm R, Burnam MA. Outcomes for adult outpatients with depression under prepaid or fee-for-service financing. Arch Gen Psychiatry. 1993;50:517–25.PubMedGoogle Scholar
  39. 39.
    Carlisle DM, Siu AL, Keeler EB, et al. HMO vs. fee-for-service care of older persons with acute myocardial infarction. Am J Public Health. 1992;82:1626–30.PubMedCrossRefGoogle Scholar
  40. 40.
    Kahn KL, Rubenstein LV, Draper D, et al. The effects of the DRG-based prospective payment system on quality of care for hospitalized Medicare patients: an introduction to the series. JAMA. 1990;264:1953–5.CrossRefPubMedGoogle Scholar
  41. 41.
    Bertakis KD, Helms LJ, Callahan EJ, Azari R, Robbins JA. The influence of gender on physician practice style. Med Care. 1995;33:407–16.CrossRefPubMedGoogle Scholar
  42. 42.
    Saha S, Taggart SH, Komaromy M, Bindman AB. Do patients choose physicians of their own race? Health Aff (Millwood). 2000;19:76–83.CrossRefGoogle Scholar
  43. 43.
    Schmittdiel J, Grumbach K, Selby JV, Quesenberry CP. Effect of physician and patient gender concordance on patient satisfaction and preventive care practices. J Gen Intern Med. 2000;15:761–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Roter DL, Geller G, Bernhardt BA, Larson SM, Doksum T. Effects of obstetrician gender on communication and patient satisfaction. Obstet Gynecol. 1999;93(5 Pt 1):635–41.CrossRefPubMedGoogle Scholar
  45. 45.
    Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999;340:618–26.CrossRefPubMedGoogle Scholar
  46. 46.
    Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999;282:583–9.CrossRefPubMedGoogle Scholar
  47. 47.
    Morales LS, Cunningham WE, Brown JA, Liu H, Hays RD. Are Latinos less satisfied with communication by health care providers? J Gen Intern Med. 1999;14:409–17.CrossRefPubMedGoogle Scholar
  48. 48.
    Perez-Stable EJ, Naapoles-Springer A, Miramontes JM. The effects of ethnicity and language on medical outcomes of patients with hypertension or diabetes. Medical Care. 1997;35:1212–9.CrossRefPubMedGoogle Scholar
  49. 49.
    Safran DG, Taira DA, Rogers WH, Kosinski M, Ware JE, Tarlov AR. Linking primary care performance outcomes of care. J Fam Pract. 1998;47:213–20.PubMedGoogle Scholar
  50. 50.
    Morales LS, Weech-Maldonado R, Spritzer KL, Elliott MN, Hays RD. Differences in CAHPS adult survey ratings and reports by race and ethnicity: an analysis of the national CAHPS benchmarking data 1.0. Health Services Research. 2001; In press.Google Scholar
  51. 51.
    Shankar S, Nanda JP, Bonney G, Kofie V. Obesity differences between African-American men and women. J Natl Med Assoc. 2000;92:22–8.PubMedGoogle Scholar
  52. 52.
    Okosun IS, Prewitt TE, Cooper RS. Abdominal obesity in the United States: prevalence and attributable risk of hypertension. J Hum Hypertens. 1999;13:425–30.CrossRefPubMedGoogle Scholar
  53. 53.
    Gillum RF. Distribution of waist-to-hip ratio, other indices of body fat distribution and obesity and associations with HDL cholesterol in children and young adults aged 4–19 years: The Third National Health and Nutrition Examination Survey. Int J Obes Relat Metab Disord. 1999;23:556–63.CrossRefPubMedGoogle Scholar
  54. 54.
    Allison DB, Fontaine KR, Manson JE, Stevens J, Vanltallie TB. Annual deaths attributable to obesity in the United States. JAMA. 1999;282:1583–8.CrossRefGoogle Scholar
  55. 55.
    Garfinkel L. Overweight and cancer. Ann Intern Med. 1985;103:1034–6.PubMedGoogle Scholar
  56. 56.
    Wee CC, McCarthy EP, Davis RB, Phillips RS. Screening for cervical and breast cancer: is obesity an unrecognized barrier to preventive care? Ann Intern Med. 2000;132:697–704.PubMedGoogle Scholar
  57. 57.
    Fontaine KR, Faith MS, Allison DB, Cheskin LJ. Body weight and health care among women in the general population. Arch Fam Med. 1998;7:381–4.CrossRefPubMedGoogle Scholar

Copyright information

© Blackwell Science Inc 2001

Authors and Affiliations

  • Carol M. Mangione
    • 1
    • 2
  • Eileen Reynolds
    • 3
  1. 1.Department of MedicineUCLA School of MedicineLos Angeles
  2. 2.the RAND Health ProgramSanta Monica
  3. 3.Department of Medicine at Beth Israel Deaconess Medical CenterHarvard Medical SchoolBoston

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