Variation in Quality of Men??s Health Care by Race/Ethnicity and Social Class

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Abstract
Until recently, minority and poor men have been characterized as “an invisible population,” overlooked by public and private efforts to improve the health status of women, children, and the elderly. This study compares the health care experiences of racial and ethnic minority men with that of white men, and low socioeconomic status with those of higher status. Quality-of-care measures in multiple clinical domains are evaluated. The authors use data from several databases, including the National Health Interview Survey, Medical Expenditure Panel Survey, and Health Care Cost and Utilization Project State Inpatient Database. The relative difference between each racial/ethnic and socioeconomic group and a fixed reference group is used to assess differences in use of services. Statistical significance is assessed using z tests. Hispanic men were much less likely to receive colorectal cancer screening (relative risk [RR] range, 0.61–0.69), cardiovascular risk factor screening and management (RR, 0.84–0.88), and vaccinations (RR, 0.47–0.94). Black and Asian men were significantly less likely to have received selected preventive services (adult immunization and colorectal cancer screening). The differences in end-stage renal disease care that black and white men received were statistically significant (RR, 0.39–0.97), with black men consistently receiving worse care. For some measures of management of end-stage renal disease, Asian men received care that was similar to or better than that received by non-Hispanic whites. Minority men are at a markedly elevated risk for the receipt of poor health care quality. However, generalizations about “minority” men are likely to be misleading and incomplete. There is a considerable variation in the magnitude, direction, and significance of these risks.