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Racial and Ethnic Variations in Office-Based Medical Care: REGRESSION ANALYSES

Posted by David in October 14th 2009

After controlling for age, gender, region and MSA status (Table 4), African-American patients receiving care for work-related conditions were found to be more than four times as likely as whites to receive mental health counseling (OR=4.60, CI: 2.03-10.44) and were 65% more likely than whites to receive physical therapy (OR=1.65, CI: 1.12-2.44). They were less than half as likely as whites to be seen by a nurse (RN or LPN) during the visit (OR=0.44, CI: 0.21-0.95). Consistent with the initial bivariate analysis, African Americans were found to be less likely than whites to see a physician (OR=0.42, CI: 0.131.37) and to have their blood pressure measured during the visit (OR=0.65, CI: 0.37-1.15), but the adjusted odds ratios for those associations were not quite statistically significant at p<0.05.

Compared to non-Hispanic patients, Hispanic patients receiving ambulatory care for work-related conditions were more than twice as likely to receive x-rays (OR=2.38, CI: 1.43-3.96 ) and almost twice as likely to have needed insurer authorization for care (OR=1.84, CI: 1.11-3.05), after controlling for age, gender, region and MSA status. Hispanics were less likely than non-Hispanics to receive a canadian prescription drugs (OR=0.60, CI: 0.43-0.84) or see a physician (OR=0.36, CI: 0.18-0.74) during the visit.
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Table 4. Regression Analysis: Effect of Patient Race/Ethnicity on Selected Characteristics of Care

		Odds Ratios and 95% Confidence Intervals
	“African-American” as the Major Independent Variable			“Hispanic” as the Major Independent Variable
Dependent Variable	Crude	Model 1	Model 2	Crude	Model 1	Model 2
Authorization from the third party payer was required for care	1.17 (0.50-2.74)	1.15 (0.57-2.32)	1.09 (0.49-2.46)	2.09 (1.32-3.29)	1.84 (1.11-3.05)	2.54 (1.39-4.64)
Blood pressure was taken during the visit	0.59 (0.34-1.04)	0.65 (0.37-1.15)	0.65 (0.33-1.26)	0.95 (0.44-2.04)	0.81 (0.41-1.61)	0.84 (0.46-1.55)
X-rays were taken during the visit	1.00 (0.49-2.03)	1.02 (0.51-2.02)	1.01 (0.50-2.04)	2.42 (1.42-4.13)	2.38 (1.43-3.96)	2.26 (1.35-3.78)
At least one drug was prescribed during the visit	0.96 (0.60-1.53)	0.95 (0.58-1.54)	0.92 (0.56-1.51)	0.67 (0.48-0,95)	0.60 (0.43-0.84)	0.71 (0.41-1.21)
Mental health counseling and education was provided	5.67 (2.37-13.58)	4.60 (2.03-10.44)	ND	0.76 (0.18-3.17)	0.83 (0.18-3.80)	ND
Physical therapy was administered during visit	1.59 (1.03-2.43)	1.65 (1.12-2.44)	1.77 (1.14-2.75)	1.44 (0.81-2.56)	1.38 (0.87-2.18)	1.47 (0.99-2.18)
Was seen by a physician (M.D.) during the visit	0.38 (0.11-1.30)	0.42 (0.13-1.37)	0.33 (0.05-2.35)	0.41 (0.17-0.97)	0.36 (0.18-0.74)	0.27 (0.12-0.62)
Was seen by a nurse (RN or LPN) during the visit	0.54 (0.27-1.10)	0.44 (0.21-0.95)	0.45 (0.19-1.03)	0.39 (0.12-1.26)	0.59 (0.22-1.57)	0.76 (0.24-2.41)
Was seen by a generalist during the visit	1.36 (0.59-3.15)	1.41 (0.71-2.79)	1.13 (0.54-2.38)	0.32 (0.16-0.66)	0.50 (0.24-1.05)	0.64 (0.28^1.47)
Was seen in a clinical/ urgent care setting	1.19 (0.68-2.06)	1.24 (0.70-2.20)	1.36 (0.68-2.72)	1.78 (1.13-2.80)	1.65 (0.90-3.03)	1.92 (1.01-3.63)

When the regression analyses were restricted to visits for work-related musculoskeletal disorders and acute injuries, we found generally the same associations and effect sizes as were reported using data from all visits, although the confidence intervals widened because there were fewer cases available for analysis and, hence, less statistical power (Table 4). The number of records available in the NAMCS data did not permit us to perform more detailed regression analyses by specific diagnosis (e.g., fractures) or body part (e.g., spine).
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