African-American and Latino patients get less neurologic care: Nationwide study

Minority patients are 30-40% less likely to visit a neurologist, even after accounting for demographic factors, insurance and health status


Contact: Altaf Saadi, M.D., or 714-943-8040
Clare Fauke, communications specialist, Physicians for a National Health program, or 312-782-6006

African-American and Hispanic patients make far fewer outpatient visits to neurologists than do their White counterparts, according to a study published in the May 18, 2017, online issue of Neurology®, the medical journal of the American Academy of Neurology. While other factors appeared to reduce access to neurologic care, including lack of health insurance, lower education, poverty and residence outside of the Northeast region, Black and Hispanic patients had significantly lower rates of neurology visits even after accounting for these other factors.

The study suggests that failure to receive adequate outpatient neurology care has medical and financial costs. Black patients with neurologic illnesses like strokes, seizures, multiple sclerosis or Parkinson's disease had more visits to emergency departments, more hospital stays and higher hospital expenditures than their non-Hispanic White counterparts.

Their study's key findings include:

  • African Americans were 30% less likely to visit a neurologist, even after accounting for demographic factors, insurance and health status differences.
  • Hispanic individuals were 40% less likely to visit neurologists.
  • These differences were NOT due to lower need for neurology care.
  • Racial and ethnic disparities were largest among individuals with stroke.
  • Racial and ethnic disparities persisted after accounting for having a usual source of care, suggesting that lack of primary care access is not the only cause of these gaps.

The authors conclude that: “These disparities are concerning not only because racial and ethnic minorities represent 28% of Americans and will become half of the U.S. population by 2040, but because all Americans should have equitable access to healthcare regardless of who they are, where they live, or what resources they have.”

The study used data from the Medical Expenditure Panel Survey covering all 50 states from 2006-2013, which surveyed about 200,000 patients and their health care providers. The research was led by Dr. Altaf Saadi, chief resident at Harvard's Partners Neurology Residency Program at Brigham and Women’s Hospital and Massachusetts General Hospital; senior author Dr. Nicte I. Mejia is an assistant professor at Harvard and Massachusetts General Hospital. Study co-authors Drs. Steffie Woolhandler and David Himmelstein are professors of public health policy at the City University of New York at Hunter College and lecturers at Harvard Medical School.

“The neurology community needs to commit ourselves to addressing these gaps,” said lead researcher Dr. Altaf Saadi. “More and more people have neurologic diseases as Americans live longer, baby boomers age and medical advances allow us to better diagnose neurologic disease. If we don’t prioritize reducing the gaps in neurologic care, we will do a disservice to our patients who need our expertise. Inadequate access to neurologic care results in unnecessary illness and disability, and increases emergency visits and hospitalizations, raising health care costs. To make health equity a reality, we must first recognize that health disparities are real and pervasive, including within neurology.”

“Studies have shown that neurologists can improve the quality of life and function of people living with neurologic diseases,” added Dr. Nicte Mejia. “Imagine experiencing incapacitating headaches and undergoing costly and often unnecessary studies that could have been prevented by seeing a neurologist. Or having Parkinson’s disease but missing out on treatments that could be improving your life while preventing costly and potentially fatal complications like falls. Minority communities need to know that neurologists exist and that we want to help improve the lives of anyone suffering from neurologic disease. Neurologists need to embrace a model of 'neurology without walls' that takes us into communities where people may need us.”

Drs. Woolhandler and Himmelstein are also affiliated with Physicians for a National Health Program, a nonprofit research and educational organization of more than 21,000 doctors who support a single-payer national health program. PNHP had no role in funding or otherwise supporting the studies or commentary described above.

A copy of the full study is available to media professionals upon request from Ms. Fauke or Dr. Saadi.