Disparities in Patient-Centered Communication for Older Latino and Black Men: Results from the Health and Retirement Study

Background: Racial/ethnic minority men experience persistent disparities in health outcomes, and report disproportionately lower quality healthcare. Minority men are often medically underserved and are less likely to receive referrals for medical specialists, to have a consistent usual source of care, to have comprehensive health insurance or to trust the healthcare system. While there are multiple factors contributing to such disparities, a lack of patient-centered communication with health providers plays an important role. Patient-centered communication (PCC) is a component of high-quality health care that privileges the patient’s perspective; emphasizes caring, trust, rapport-building, shared decision-making, and is inclusive of the social and emotional wellbeing of the patient. Here, we sought to identify both potential racial differences in the experience of PCC and socio-demographic, health-related and health access factors that influence older men's experiences with PCC.

Methods: We analyzed data, on five indicators of PCC representative of interactions with doctors and nurses from (N=3082) non-Latino White (NLW), Latino/Hispanic, and Black males from the 2010 Health and Retirement Study (HRS) Core and the linked HRS 2011 Health Care Mail Survey. The mean age of respondents was 66.76 years (10.79, SD). Five PCC outcomes included: In the last twelve months, how often did the doctors and nurses: 1) explain things in a way that is easy to understand; 2) listen carefully to you; 3) show respect for what you had to say; 4) spend enough time with you; and 5) Overall, how satisfied are you with the doctors and nurses you have seen. For each outcome, binary logistic regressions were run to predict the odds of reporting affirmatively to each statement above. The primary independent variable was Race/Ethnicity (i.e. Black and Hispanic/Latino compared to white males) and covariates included age, education, marital status, insurance status, place of care, and self-rated health among additional health and healthcare access factors.

Results: Across all initial models, both Black and Hispanic/Latino men had lower odds of reporting affirmative PCC experiences compared to White men (p<.05). These differences attenuated as additional models controlled for socio-demographic, health, and health access factors. For two outcomes, how often did the doctors and nurses explain things in a way that is easy to understand and spend enough time with you, race/ethnic differences persisted in that for both cases, older Hispanic/Latino men had 40% lower odds of reporting these facets of PCC compared to White men. Several demographic, health and access factors also predicted facets of PCC.

Conclusions and Implications: These findings reinforce that older Black and Latino/Hispanic men continue to face barriers to accessing PCC with serious potential implications for disparate health outcomes. Continued investigation of additional factors that predict PCC among minority men can illuminate intervention points. Social work researchers and health practitioners should continue to explore the impact of time-limited medical visits and implicit racial bias on medical encounters for underrepresented patients, and to advocate for accessible, inclusive, and responsive communication between minority male patients and their health providers.