The predictors of patient-physician race and ethnic concordance: a medical facility fixed-effects approach

Health Serv Res. 2010 Jun;45(3):792-805. doi: 10.1111/j.1475-6773.2010.01086.x. Epub 2010 Mar 10.

Abstract

Objective: To examine the predictors of patient-physician race/ethnicity concordance among diabetes patients in an integrated delivery system.

Data source: Kaiser Permanente's Northern California Diabetes Registry of 2005.

Study design: Logistic regression predicted concordance for each racial/ethnic group. Availability of a concordant physician, whether a patient chose their physician, and patient language were main explanatory variables.

Data collection/extraction methods: The study population consisted of 109,745 patients and 1,750 physicians.

Principal findings: Patients who chose their physicians were more likely to have a same race/ethnicity physician with OR of 2.2 (95 percent CI 1.74-2.82) for African American patients, 1.71 (95 percent CI 1.44-2.04) for Hispanic patients, 1.11 (95 percent CI 1.04-1.18) for white patients, and 1.38 (95 percent CI 1.23, 1.55) for Asian patients. Availability of a same race/ethnicity physician was also a predictor of concordance for African American patients (OR 2.7; 95 percent CI 2.45-2.98) and marginally significant for Hispanic patients (OR 1.02; 95 percent CI 1.01-1.02), white patients (OR 1.02; 95 percent CI 1.00-1.04), and Asian patients (OR 1.05; 95 percent CI 1.03, 1.07). Limited English language was a strong predictor of concordance for Hispanic patients (OR 4.81; 95 percent CI 4.2-5.51) and Asian patients (OR 9.8; 95 percent CI 7.7, 12.6).

Conclusion: Patient language, preferences, and the racial composition of the physician workforce predict race/ethnicity concordance.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • African Americans / education
  • African Americans / ethnology*
  • African Americans / statistics & numerical data
  • Asian Americans / education
  • Asian Americans / ethnology*
  • Asian Americans / statistics & numerical data
  • California
  • Choice Behavior
  • Diabetes Mellitus / ethnology
  • European Continental Ancestry Group / education
  • European Continental Ancestry Group / ethnology*
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Health Maintenance Organizations
  • Healthcare Disparities
  • Hispanic Americans / education
  • Hispanic Americans / ethnology*
  • Hispanic Americans / statistics & numerical data
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multilingualism
  • Multivariate Analysis
  • Patient Acceptance of Health Care / ethnology*
  • Physician-Patient Relations*
  • Physicians / psychology
  • Physicians / supply & distribution
  • Workforce