The authors examined 78 conditions treated in acute care hospitals to identify possible variations in medical treatment by race and gender among blacks and whites. Data for the study were obtained using 1.7 million inpatient discharge abstracts from the 1986 Hospital Cost and Utilization Project, a national sample of about 500 hospitals in the United States.

The two dependent variables examined included occurrence of a major therapeutic procedure and occurrence of a major diagnostic procedure without a major therapeutic procedure. Logistic regression analysis was used to describe the influence of age and gender among blacks and whites on the likelihood of having a major therapeutic or major diagnostic procedure, controlling for patient age, disease severity, health insurance, and hospital-level characteristics.

“Blacks were significantly less likely than whites to receive a major therapeutic procedure in 48.1% of 77 diagnostic categories, and they were more likely than whites to receive a major therapeutic procedure in 9.1% of these disease categories. There were no significant differences in 42.8% of the disease categories. In contrast, blacks were less likely than whites to receive a major diagnostic procedure without a major therapeutic procedure in 20.8% of disease categories, and were significantly more likely than whites to receive a major diagnostic procedure in 13.0% of disease categories. There were no significant differences between the races in receiving a major diagnostic procedure in 66.2% of 77 disease categories.”

“With respect to the specific conditions for which there were racial differences, certain patterns emerged. For nearly all the diseases of the female reproductive system, black women had a significantly lower rate of therapeutic procedures than white women. Significant differences also were found in the rate of therapeutic procedures for several cancers, including colon or rectal cancer, bladder cancer, breast cancer, and uterine and cervical cancer.”

“There may be other possible explanations for differences in treatment by race…Sociocultural differences between groups may influence patient and physician decision-making. These include differences in health seeking behavior, patient adherence to treatment regimens, patient preferences for treatment, communications and interactions with the health care provider, patient’s presentation style, and the availability of social supports. There also may be differences in medical acculturation, education levels, or assertiveness between racial and gender groups that leads to differences in patients’ seeking and preferring specific treatments.”

“Access to different types of hospitals and providers may contribute to variations in treatment.”

“Disparities may result from racial or gender stereotypes or physician biases solely on race or gender that are not supported by biomedical differences.”

“If the disparities in treatments observed in this investigation are accepted as real, it still is not possible to conclude whether blacks and females are receiving too few procedures or whether whites and males are receiving too many.”