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In U.S. counties with more Black doctors, Black patients live longer

By Louise Kinross

Black people in American counties with more Black primary-care doctors live longer, particularly in areas with high poverty rates, according to a population-based study published last week in JAMA Network Open. The study is the first of its kind.

It found Black residents in counties with more Black physicians—whether or not they are treated by those doctors—had lower death rates from all causes, and lower disparities in mortality rates between Black and white residents. Longer survival was found in counties with even one Black doctor.

Researchers from the U.S. Department of Health and Human Services looked at the association of Black doctors with survival outcomes at three time points in 2009, 2014 and 2019 in 1,618 U.S. counties. They noted that life expectancy disparities between Black and white people have persisted for decades, with little improvement.

On average, they found every 10 per cent increase in county-level Black doctor representation increased the life expectancy of Black patients by about a month. County-level representation was defined as the proportion of primary-care physicians who identified as Black divided by the proportion of the population who identified as Black.

When the scientists began in 2009, over half of America's 3,142 counties had to be excluded from the study because they didn't have a single Black primary care provider. The percentage of Black doctors in the 1,168 counties studied in 2009, 2014 and 2019 was 5.7 per cent, 6.3 per cent and 6.7 per cent. In contrast, Black residents made up 13 to 13.4 per cent of the total U.S. county-level population from 2009 to 2019.

The study did not look at why more Black doctors increased the lives of Black people. Previous studies have found that when Black patients are treated by Black doctors, they're more satisfied with their care and more likely to receive preventative care, according to this related editorial by Dr. Monica Peek, who specializes in general internal medicine and preventive health for adults at the University of Chicago Medicine. She studies how to reduce health-care disparities in diabetes care and breast cancer-screening education for African American patients.

"While there is evidence to support potential mechanisms by which Black physicians working within the health-care system can improve health outcomes for Black patients (e.g. increased shared decision-making and patient-centred care, culturally concordant care, increased quality of care), there is also evidence that Black physicians are more likely than physicians from other racial or ethnic groups to engage in health-related work outside the health-care system," Monica wrote.

"That is, Black physicians are more likely to provide health-related expertise to local community organizations (e.g. school boards, local media); to be politically involved in health-related matters at the local, state, or national level; and to encourage medical organizations to advocate public health (e.g. air pollution, gun control, increased literacy, substance-abuse prevention)."

The study noted that non-white physicians are more likely to treat low-income and uninsured patients.

According to a 2016 Statistics Canada report, just 2.3 per cent of Ontario’s physician workforce is Black, compared to 4.7 per cent of the population. This recent piece in the Ontario Medical Review looks at ways to increase Black medical students.

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