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Study finds racial disparities in receipt of state-of-the-art care for HIV disease

A recent study conducted by researchers at the University of California, Los Angeles, found that in 1996, black patients with HIV who were treated by white doctors were less likely than white patients treated by the same doctors to receive life-saving HIV medication. In the study, which was funded in part by the Agency for Healthcare Research and Quality (HS08578), the researchers analyzed data on a national probability sample of 1,241 adults receiving HIV care with linked data from 287 providers. They examined the association between patient-provider racial concordance and time from first FDA approval of the first protease inhibitor to the time when individual patients first received a protease inhibitor.

Results of the analysis show that black patients treated by white doctors received their HIV medications nearly 4 months later than black patients who were treated by black doctors. There was no correlation between the delayed treatment and the patients' income levels, years of education, or insurance coverage. Similarly, doctors' knowledge, specialty, extent of training, and years of experience did not affect the results. In the end, black patients seen by black doctors received better care than black patients seen by white doctors.

These findings are significant for several reasons, according to the study's lead investigator. William D. King, M.D., J.D. of the UCLA Robert Wood Johnson Clinical Scholars Program. First, this study advances prior research in the field by demonstrating that patient-provider racial concordance can impact access to medical treatment. It is the first study to demonstrate this effect. Second, the study findings underscore the importance of incorporating patient-provider racial concordance in analyses of patient-provider relationships, particularly analyses involving racial disparities.

Since the time of this study (1996), HIV treatment strategy has moved away from early antiretroviral use and toward a "wait and see" approach to initiating treatment. However, at the time when participants were enrolled in the study, the prevailing opinion among HIV experts was that protease inhibitors were crucial in reducing HIV-related illnesses and deaths and should be started as soon as possible in patients who could tolerate them. Dr. King and his colleagues note that regardless of their clinical implications, these study findings indicate that race concordance influences the delivery of state-of-the-art care.

For more details, see "Does racial concordance between HIV-positive patients and their physicians affect the time to receipt of protease inhibitors?" by Dr. King, Mitchell D. Wong, M.D., Ph.D., Martin F. Shapiro, M.D., Ph.D., and others, in the November 2004 Journal of General Internal Medicine 19, pp. 1147-1153.

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