Does racial concordance between HIV-positive patients and their physicians affect the time to receipt of protease inhibitors?
Does racial concordance between HIV-positive patients and their physicians affect the time to receipt of protease inhibitors?
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DOI：
10.1111/j.1525-1497.2004.30443.x
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发表时间：
2004-11-01
影响因子：
5.7
通讯作者：
Cunningham, WE
中科院分区：
文献类型：
--
作者：
King, WD;Wong, MD;Cunningham, WE
背景：与白人相比，非洲裔美国人有更高的艾滋病发病率和死亡率，部分原因是他们较少使用有效的抗逆转录病毒治疗。为什么在抗逆转录病毒使用方面存在种族差异尚不完全清楚。我们检查了种族一致性（患者和提供者具有相同的种族）是否影响接受蛋白酶抑制剂的时间。方法：我们分析了一项前瞻性队列研究的数据，该研究的全国概率样本包括1241名接受艾滋病毒治疗的成年人，以及来自287名提供者的相关数据。从美国食品和药物管理局批准第一个蛋白酶抑制剂到患者第一次接受蛋白酶抑制剂，我们研究了患者-提供者种族一致性与时间之间的关系。结果：在我们未经调整的模型中，白人患者接受蛋白酶抑制剂治疗的时间远早于非裔美国患者（中位277天比439天；P < 0.0001）。仅调整患者特征，非裔美国患者接受蛋白酶抑制剂治疗的时间明显晚于非裔美国患者接受蛋白酶抑制剂治疗的时间（分别为461天和342天，P < 0.001）和白人患者接受蛋白酶抑制剂治疗的时间（分别为461天和353天，P= 0.001）。在该模型中，非裔美国患者与白人患者在非裔美国医疗服务提供者和白人医疗服务提供者之间没有差异（分别为342天和353天；P < 0.05）。调整患者对提供者的信任，以及后续模型中的其他患者和提供者特征，并没有考虑到这些差异。结论：患者-提供者种族一致性与HIV感染者接受蛋白酶抑制剂治疗的时间有关。种族一致性应在计划、政策和未来的种族和民族健康差异研究中得到解决。
BACKGROUND: Compared to whites, African Americans have been found to have greater morbidity and mortality from HIV, partly due to their lower use of effective antiretroviral therapy. Why racial disparities in antiretroviral use exist is not completely understood. We examined whether racial concordance (patients and providers having the same race) affects the time of receipt of protease inhibitors.METHODS: We analyzed data from a prospective, cohort study of a national probability sample of 1,241 adults receiving HIV care with linked data from 287 providers. We examined the association between patient-provider racial concordance and time from when the Food and Drug Administration approved the first protease inhibitor to the time when patients first received a protease inhibitor.RESULTS: In our unadjusted model, white patients received protease inhibitors much earlier than African-American patients (median 277 days compared to 439 days; P < .0001). Adjusting for patient characteristics only, African-American patients with white providers received protease inhibitors significantly later than African-American patients with African-American providers (median 461 days vs. 342 days respectively; P < .001) and white patients with white providers (median 461 vs. 353 days respectively; P= .002). In this model, no difference was found between African-American patients with African-American providers and white patients with white providers (342 vs. 353 days respectively; P > .20). Adjusting for patients' trust in providers, as well as other patient and provider characteristics in subsequent models, did not account for these differences.CONCLUSION: Patient-provider racial concordance was associated with time to receipt of protease inhibitor therapy for persons with HIV. Racial concordance should be addressed in programs, policies, and future racial and ethnic health disparity research.