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Anne James Boyd, MD, Pediatrics, University of Michigan, P.O. Box 3156, Ann Arbor, MI 48106, 7347099991, ajboydmd@stanfordalumni.org, Mohsen Bazargan, PhD, Family Medicine, Charles R. Drew University, 12021 S. Wilmington Ave, Los Angeles, CA 90059, and Frederick W. James, MD, Pediatrics, Charles R. Drew University, 12021 S. Wilmington Ave, Los Angeles, CO 90059.
Background: Increased mortality and serious delay in treatment have been reported in African American (AA) children with complex but treatable CHD as compared to White children with similar defects.
Objective: To study provider perceptions of the contribution of pre-selected variables to MM, and ethnic disparity in health outcome (EDHO) in children with CHD.
Design/Methods: Data were collected from a mail survey of 576 (53% respondents) of 1082 pediatric cardiologists from the American College of Cardiology and American Medical Association databases. Respondents scored the magnitude of perceived contributing variables to MM and EDHO using a scale of 1 (not important) to 7 (very important). Providers were divided into 3 Groups by race/ethnicity: Gr 1- White (81%), Gr 2- Asian (11%), and Gr 3- Other Americans (8%), and also by age, gender, and practice characteristics. Twenty-six different variables were consolidated into 5 Domains: 1.) Parental knowledge, attitude and behaviors, 2.) Socio-economic status, 3.) Family structure, 4.) Biological factors, and 5.) Health system characteristics. Within the Domains, the reliability coefficients for the included variables were > 0.74. Data were analyzed using bivariate statistics.
Results: For MM, providers had the highest mean scores in health system characteristics followed by parental knowledge and SES, all of which were significant from biological factors. (p<0.04) Providers <40 years had greater mean scores in domains 4, 5 than those 40 and older. (p<0.01) Domains 1, 3 in Gr 1 and domains 1, 2, 3 in Gr 2 were positively related to the percent of AA in the medical practice. (p<0.02) For EDHO, providers recorded higher mean scores in domains 1, 2 than in domains 3, 4. (p<0.001) Gr 2 scored higher in domains 1 to 4 with the highest in domains 1, 2 than both Gr 1 and Gr 3. (p<0.03) Women recorded higher mean scores than men in all domains with significant differences in 1 and 2. (p<0.01) Young physicians were more likely to attribute differences in EDHO to biological factors as compared to those >40 years. (p<0.01)
Conclusions: This study reveals marked variability in perceptions when considering providers race/ethnicity, age, gender, and practice characteristics. Although providers attribute EDHO to health system characteristics, subgroup analyses demonstrate that parental and social factors are attributed to poor health outcomes in AA children with CHD. Further education and research are needed to eliminate variability in provider perceptions, which may favorably change MM and EDHO.
Learning Objectives:
Keywords: Ethnic Minorities, Health Disparities
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.