The Role of Doctor-Patient Race Concordance in U.S. Health Disparities

It has been established that much of the disparity in health outcomes between blacks and whites can be explained by accounting for education and income. Once education and income have been taken into consideration, research has found racial disparities in health outcomes for low-income populations are small, and in some cases no longer significant. For middle and upper income populations, however, a significant racial disparity in health outcomes persists even after accounting for education and income. Seeking to explain this variation, I analyze the literature concerning health disparities, race and class, the prevalence and distribution of black physicians, and issues and trends surrounding physician-patient communication and discrimination. I find that black physicians tend to be concentrated in low-income, minority-dense areas, therefore, the likelihood of a black middle or upper class person seeing a doctor of their same race may be less than that for lower class blacks. I hypothesize that doctor-patient racial concordance, and the associated possibility of diminished communication and cultural hurdles endured by black patients visiting a black doctor, may explain some of this variation in the magnitude of racial health disparities along the education/income spectrum, explaining the larger racial health disparities in middle and upper-income populations. Using data from the 2006 Commonwealth Fund Health Care Quality Survey (N=1591), I conducted bivariate (chi-sq/t-tests) and step-wise multivariate, logistic regression statistical tests to explore if doctor-patient racial concordance affects the self-rated health of American adults. This analysis showed concordance as a significant predictor of self-rated health in the unadjusted model, but not in the full model. Simply put, concordance is a significant predictor of self-rated health, but not independent of socioeconomic factors. My modeling is consistent with the literature in showing education and income as the most significant predictors of health status