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Health Serv Res. 2008 Apr;43(2):531-51. doi: 10.1111/j.1475-6773.2007.00770.x.

Testing for statistical discrimination by race/ethnicity in panel data for depression treatment in primary care.

Author information

  • 1Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA.

Abstract

OBJECTIVE:

To test for discrimination by race/ethnicity arising from clinical uncertainty in treatment for depression, also known as "statistical discrimination."

DATA SOURCES:

We used survey data from 1,321 African-American, Hispanic, and white adults identified with depression in primary care. Surveys were administered every six months for two years in the Quality Improvement for Depression (QID) studies. Study

DESIGN:

To examine whether and how change in depression severity affects change in treatment intensity by race/ethnicity, we used multivariate cross-sectional and change models that difference out unobserved time-invariant patient characteristics potentially correlated with race/ethnicity.

DATA COLLECTION/EXTRACTION METHODS:

Treatment intensity was operationalized as expenditures on drugs, primary care, and specialty services, weighted by national prices from the Medical Expenditure Panel Survey. Patient race/ethnicity was collected at baseline by self-report.

PRINCIPAL FINDINGS:

Change in depression severity is less associated with change in treatment intensity in minority patients than in whites, consistent with the hypothesis of statistical discrimination. The differential effect by racial/ethnic group was accounted for by use of mental health specialists.

CONCLUSIONS:

Enhanced physician-patient communication and use of standardized depression instruments may reduce statistical discrimination arising from clinical uncertainty and be useful in reducing racial/ethnic inequities in depression treatment.

PMID:
18370966
[PubMed - indexed for MEDLINE]
PMCID:
PMC2442383
Free PMC Article
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