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Blacks, Latinos Miss Out on Drugs for Back Pain

Whites and women prescribed more pills, research says

WEDNESDAY, June 2, 2004 (HealthDayNews) -- In a new look at the old problem of racial disparities in health care, researchers have found black and Latino patients with back pain are much less likely to receive painkillers than whites, especially if they're male.

The meaning of the findings, however, isn't entirely clear. One of the study's authors said his work indicates the presence of racism, but another expert said the reasons behind the disparity may be more complex.

Augustine J. Kposowa, a professor of sociology at the University of California at Riverside, launched the study to explore how race affects health care. "I was just curious as to whether the health-care system is as race- or color-blind as it usually assumed," he said. "If you have a headache, it shouldn't matter if you're black, Latino or white."

Kposowa decided to look at back pain because an estimated 50 percent of the U.S. population will suffer from it during their lifetimes. He and a colleague from Western Washington University then examined statistics about back pain from a 1995-1998 survey called the U.S. National Hospital Ambulatory Medical Care Survey.

The results of the study appear in the latest issue of Race & Society.

Blacks and Latinos were about a third less likely than whites to receive prescriptions for painkillers. Black and Latino men, meanwhile, were about half as likely as white men to receive prescription painkillers; the statistics suggested that black men even had problems getting orders for over-the-counter drugs.

Disparities remained even when the researchers compared patients with similar types of insurance (or no insurance) or those whose X-rays showed similar levels of back problems.

Kposowa, a native of the African country of Sierra Leone, was surprised. "I wasn't expecting racial differences. I was expecting more differences in terms of insurance coverage."

Race wasn't the only factor separating the level of care for patients. Women, especially Asians, were more likely than men to get painkillers, perhaps because of stereotypes suggesting they're more docile than men, Kposowa said.

The income of the patients could play a role, but other studies have suggested it doesn't, Kposowa said. For another thing, "when you visit a hospital, your socioeconomic status is not immediately perceived. You walk in there, and the physician is not going to immediately say this person is a very healthy person, or this person has a Ph.D. or M.D. However, your race and the color of your skin are immediately visible."

What's going on? "Contrary to popular belief, the health care in the United States is not immune to what's going on in the general culture," Kposowa said. "In the general culture, there are stereotypes about groups. Physicians, like everyone else, are influenced by these stereotypes."

Racial disparities do indeed exist in American health care, said Dr. Leonard E. Egede, an assistant professor of medicine at the Medical University of South Carolina who studies race and medicine. But he added that racism is difficult to measure and, in this case, it's possible the study may not have taken into account chronic diseases that may have affected the patients and influenced decisions about prescriptions. Also, it's possible doctors told some of the patients to buy over-the-counter drugs on their own.

Even so, the findings could be yet another sign of major disparities in health care, Egede said. "As studies like this continue to be published, they increase awareness about the problem, but we also need to take the bigger society into context. A lot of the things we see in the health-care system are reflections of the societal problems that have been there for generations. It's a reflection of a larger problem in society than just the health-care system alone."

More information

The U.S. government is working to prevent racial disparities in health care. Learn about its current initiative here.

SOURCES: Augustine J. Kposowa, Ph.D., professor, sociology, University of California, Riverside; Leonard E. Egede, M.D., M.S., assistant professor, medicine, Medical University of South Carolina, Charleston; April 9, 2004, online edition, Race & Society
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