“After adjusting for patient and hospital characteristics (ie, removing the effect caused by blacks and people from poor neighborhoods receiving care in better hospitals), patients who were black or from poor neighborhoods have worse processes of care.”

“Patients who were black or from poor neighborhoods were more likely to be discharged in an unstable condition after adjustment for sickness at admission, patient and hospital characteristics, disease, state, and time period (P<.001).”

“After adjusting for all covariates, patients who were black or from poor neighborhoods average 12.6 hospital days, compared with 12.0 hospital days for the other patients. (P<.05)”

No significant differences were found in mortality rates.

“Further research is needed to clarify whether sociocultural and educational incongruity between providers and patients translates into misunderstandings about patients’ preferences and expectations, and to evaluate the extent to which stereotyping, discrimination, or bias exist in the hospital setting…. We report that racial characteristics and poverty status also influence the quality of care received by acutely ill, insured patients after they have gained access to the hospital.”

Ayanian J.
Race, Class, and Quality of Medical Care. (Editorial)
JAMA. 1994; 271(15): 1207-1208.

The studies by Kahn et al. and Peterson et al. “provide some reassurance that such disparities do not translate into higher mortality rates for patients who are black or poor. However, the goal of most hospital care is to improve patients’ functioning and quality of life. Differences in treatment by race and class may have their greatest impact on these more subtle, but critical, outcomes.”