Patient-provider sex and race/ethnicity concordance: a national study of healthcare and outcomes

Med Care. 2011 Nov;49(11):1012-20. doi: 10.1097/MLR.0b013e31823688ee.

Abstract

Background: Increasing patient-provider sex and race/ethnicity concordance has been proposed to improve healthcare and help mitigate health disparities, but the relationship between concordance and health outcomes remains unclear.

Objective: To examine associations of patient-provider sex, race/ethnicity, and dual concordance with healthcare measures.

Research design and participants: Analyses of data from adult respondents indicating a usual source of healthcare (N=22,440) in the 2002 to 2007 Medical Expenditure Panel Surveys (each a 2-year panel).

Measures: Year 1 provider communication, sex-neutral (colorectal cancer screening, influenza vaccination) and sex-specific (mammography, Papanicolaou smear, prostate-specific antigen) prevention; and year 2 health status (SF-12). Analyses adjusted for patient sociodemographics and health variables, and healthcare provider (usual source of care) sex and race/ethnicity.

Results: Of 24 concordance assessments, 3 were statistically significant. Women with female providers were more likely to report mammography adherence [average adjusted marginal effect=3.9%, 95% confidence interval (CI): 1.6%, 6.2%; P<0.01]. Respondents reporting dual concordance were less likely to rate provider communication in the highest quartile (average adjusted marginal effect =-4.2%, 95% CI: -8.1%, -0.2%; P=0.04), but dual concordance was associated with higher adjusted SF-12 Physical Component Summary scores (0.58 points, 95% CI: 0.00, 1.15; P=0.05).

Conclusions: Little evidence of clinical benefit resulting from sex or race/ethnicity concordance was found. Greater matching of patients and providers by sex and race/ethnicity is unlikely to mitigate health disparities.

MeSH terms

  • African Continental Ancestry Group / statistics & numerical data
  • Continental Population Groups / statistics & numerical data*
  • Ethnic Groups / statistics & numerical data*
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Health Status
  • Hispanic Americans / statistics & numerical data
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Patient Satisfaction / statistics & numerical data
  • Physician-Patient Relations*
  • Preventive Medicine / standards
  • Preventive Medicine / statistics & numerical data
  • Quality Indicators, Health Care / statistics & numerical data
  • Quality of Health Care / statistics & numerical data*
  • Sex Factors
  • Socioeconomic Factors
  • United States / epidemiology