Racial and Ethnic Disparities in Alzheimer's Disease: A Literature Review. Racial and Ethnic Discrimination


Although discrimination by providers against racial and ethnic minorities in the United States is commonly asserted as the cause of racial and ethnic disparities, we were unable to find any empirical studies on this topic that focused on people with Alzheimer's disease. Indeed, there appear to be few empirical studies on this topic in health care.

A rare study of discrimination in health care used the implicit association test to assess the degree to which implicit racial bias affected physicians' decisions on thrombosis (Green et al., 2007). A total of 287 internal and emergency medicine residents from four hospitals in Boston and Atlanta participated in an online study. Half of the physicians received information about a White patient, and the other half received the same information but were told that the patient was African American. Although physicians self-reported that they did not prefer treating one group or the other and did not see either group as more cooperative, the test found a preference for treating Whites and the perception that African Americans were less cooperative. Similarly, Blanchard and Lurie (2004) found that minorities were more likely to report being looked down upon or treated with disrespect than Whites. Specifically, adjusting for sex, language, income, insurance coverage, and education, 20% of Asians, 19% of Hispanics, and 14% of Blacks reporting being treated disrespectfully or looked down upon by their provider compared to 9% of Whites.

Although not specifically about Alzheimer's disease, the Institute of Medicine's (IOM's) Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (Smedley et al., 2003) identified racial bias and prejudice (conscious and unconscious) as obvious potential reasons for differences in treatment for a number of diseases. Provider lack of empathy and limited contact with people of other races/ethnicities were identified as potential factors. The IOM report also cites the theory that the pressures of the health care environment can lead to providers stereotyping patients as a cognitive shortcut, which reduces the amount of time they need to spend with patients. The common tendency to see the patient-provider relationship as one of a lower-status person coming to a higher-status person for assistance, rather than a relationship between collaborators--regardless of race or ethnicity--could be a barrier to quality care.

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