A pioneering study published recently in the Journal of the American Academy of Neurology has found that black and Latino patients suffering from neurological ailments like stroke, Parkinson’s disease and Alzheimer’s dementia are likely to receive significantly different and less adequate care than white patients.
This discrepancy in treatment, which impacts diagnosis, specialist care, treatment and recovery, the research team discovered, exists even when the patients of different races or ethnicity have similar incomes, insurance coverage and levels of education.
The findings of the study replicate similar findings involving the provision of medical care to victims of heart disease, breast cancer and diabetes. For example, in 2014 a report by the Robert Wood Johnson Foundation found that the medical treatment provided to African-Americans, Latinos and other minorities was deficient compared to whites, even for patients with similar incomes and insurance coverage for heart disease, stroke, breast cancer and diabetes.
This latest study, which looked at nationwide data on treatment of “any self-identified neurological disorder except back pain,” as well as five specific ailments (Parkinson's disease, multiple sclerosis, headache, cerebrovascular disease and epilepsy) covering a period from 2006 to 2013, is the first to focus specifically on neurological ailments and conditions, and on gaining access to a neurologist.
“The big issue with neurology is getting through the door to see a neurologist,” said Dr. Steffie Woolhandler, a professor of public health and health policy at Hunter College in the City University of New York, and one of the study’s authors. “We found that those people with neurological diseases who saw a neurologist were much more likely to be white, higher income and better educated.” But she said the study also found that even when looking at people of different races and ethnicities who had the same income, insurance coverage and level of education, there was still a greater likelihood that white patients would see a neurologist.
The study, which involved about 280,000 patients, found that black patients were nearly 30 percent less likely to see an outpatient neurologist than white counterparts of similar resources and education. Latino patients were 40 percent less likely to see a neurologist for their condition than whites. Blacks were also considerably more likely to be cared for in emergency departments and to have longer hospital stays and higher inpatient expenditures than their white counterparts.
Dr. Altaf Saadi, a neurologist and chief resident at Massachusetts General and Brigham and Women’s Hospital in Boston, the lead researcher on the study, says the solution to the problem of obtaining better care for minority patients “needs to be multi-level.”
Part of the problem, she explained, is informational. “There needs to be more knowledge about neurological diseases in minority communities,” she said in an interview, citing cancer screenings as an example where increased community outreach and education efforts have been notably successful at narrowing the gap in treatment between white and minority patients. But Saadi added says that there are also problems of bias and unconsciously held stereotypes among both referring physicians and neurologists themselves regarding the treatment of minority patients with neurological problems.
“Take Alzheimer's,” Saadi said. “So much depends, in that case, on the physician’s interaction with the patient and the family. And to think that wouldn’t be influenced by stereotypes on the part of the physician is not being realistic about human nature.”
She added, “There has been a lot of work done on how to do bias training in other parts of the medical profession, and I think it clearly needs to be done also with the neurological profession, and on a continual basis, not just as a one-time thing. It also needs to be done with primary care physicians, because we also found that even among people with a primary care physician, blacks and Hispanics were less likely to be referred to see a neurologist.”
Woolhandler, a co-founder of Physicians for a National Health Program, a leading physician advocacy group pushing for single-payer health care in the U.S., says that while there are cultural issues that could deter some blacks and Latinos from seeking out a neurologist who is likely to be white and to work at some relatively remote office location, “It’s really a problem on both sides. The physicians need to work to make minority patients feel welcome too,” she says, “and in the case of non-English speakers, to be able to communicate with them.”
The study concludes that remedying the observed disparities in neurological care between white patients and patients of color “will require that neurologists engage with policy discussions regarding health insurance coverage and interventions to improve access. It also states that neurologists should “participate in initiatives to educate hospital staff about bias and multicultural care, increase the proportion of underrepresented minorities in the neurology workforce, improve patient education and literacy regarding neurologic illness, and transform institutional practices to assure more equitable neurologic care.”