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(Circulation. 2005;111:1264-1269.)
© 2005 American Heart Association, Inc.

Health Services and Outcomes Research

Racial and Ethnic Disparities in Care

The Perspectives of Cardiologists

Nicole Lurie, MD, MSPH; Allen Fremont, MD, PhD; Arvind K. Jain, MS; Stephanie L. Taylor, PhD; Rebecca McLaughlin, BA; Eric Peterson, MD, MPH; B. Waine Kong, PhD, JD; T. Bruce Ferguson, Jr, MD

From the RAND Corporation, Arlington, Va, and Santa Monica, Calif (N.L., A.F., A.K.J., S.L.T., R.M.); Duke University, Durham, NC (E.P.); American College of Cardiology, Bethesda, Md (E.P.); Association of Black Cardiologists, Atlanta, Ga (B.W.K.); Louisiana State University, Baton Rouge (T.B.F.); and Society of Thoracic Surgeons, Chicago, Ill (T.B.F.).

Correspondence to Nicole Lurie, MD, MSPH, RAND Corporation, 1200 S Hayes St, Arlington, VA 22202. E-mail lurie{at}rand.org

Received October 27, 2004; revision received January 6, 2005; accepted January 11, 2005.

Background— Despite extensive documentation of racial and ethnic disparities in care, provider awareness of disparities has been thought to be low. To be effective, educational efforts for physicians must consider providers’ knowledge and beliefs about what causes disparities and what can be done about them.

Methods and Results— We conducted a Web-based survey of 344 cardiologists to determine their level of awareness of disparities and views of underlying causes. Responses were assessed by means of 5-point Likert scales. Thirty-four percent of cardiologists agreed that disparities existed in care overall in the US healthcare system, and 33% agreed that disparities existed in cardiovascular care. Only 12% felt disparities existed in their own hospital setting, and even fewer, 5%, thought disparities existed in the care of their own patients. Despite this, most respondents rated the strength of the evidence about disparities as "very strong" or "strong." Respondents identified many potential causes for disparities in care but were more likely to endorse patient and system level factors (eg, insurance status or adherence) rather than provider level factors.

Conclusions— Cardiologists’ awareness of disparities in care remains low, and awareness is inversely proportional to proximity to their own practice setting.

Key Words: cardiovascular diseases • ethnic groups • physicians • public policy • quality of health care

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