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Health Care Disparities/Minority Health

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Attitude toward risk does not fully explain sociodemographic disparities in health care use

Many studies have documented substantial variations in health care use related to race and sex. However, little is known about how risk attitudes toward health-related decisions that influence use of care vary across important sociodemographic groups.

The first study to examine variations in risk attitude by race and sex reveals that blacks are more risk-seeking relative to whites, even after adjustment for educational status, and that individuals with no college education are more risk-averse than those with some college education. Women tend to be more risk-averse than men, but age does not appear to be associated with risk attitude.

The underuse of appropriate health care services among blacks could be related to this group's relative risk-prone posture. Blacks may be more willing to live with the risks of their underlying diseases and thus undergo fewer procedures. However, women and those with lower educational attainment, who are more risk averse, also generally underuse health care. Clearly, risk attitude alone does not explain sociodemographic disparities in health care use. A better understanding of how risk posture varies with demographics and how these variations affect decisionmaking may facilitate efforts to better understand sociodemographic disparities in health care use, concludes Allison B. Rosen, M.D., M.P.H., of the Harvard School of Public Health.

In the study, which was supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00020), Dr. Rosen and her colleagues examined the relationship between risk attitude and sociodemographics by surveying 65 adult patients from one medical system. They used several questionnaires to explore patients' attitudes about whether they were willing to risk certain health states for others or certain outcomes versus a riskier, but perhaps better outcome. The adults clustered around moderate risk aversion, with a median risk attitude of 0.70. Although blacks were more risk seeking that whites, both groups were risk averse, with median risk postures of 0.8 for blacks and 0.69 for whites.

More details are in "Variations in risk attitude across race, gender, and education," by Dr. Rosen, Jerry S. Tsai, M.S., and Stephen M. Downs, M.D., M.S., in the November 2003 Medical Decision Making 23, pp. 511-517.

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