Racial differences in patients' perceptions of debilitated health states

OBJECTIVE: To determine health utility scores for specific debilitated heal th states and to identify whether race or other demographic differences pre dict significant variation in these utility scores. DESIGN: Utility analysis. SETTING:A community hospital general internal medicine clinic. a private in ternal medicine practice. and a private pulmonary medicine practice. PARTICIPANTS: Sixty-four consecutive patients aged 50 to 75 years awaiting appointments. In order to participate, patients at the pulmonary clinic had to meet prespecified criteria of breathing impairment. MEASUREMENTS: Individuals' strength of preference concerning specific state s of limited physical function as measured by the standard gamble technique . MAIN RESULTS: Mean utility scores used to quantitate limitations in physica l function were extremely low. Using a scale for which 0 represented death and 1.0 represented normal health. limitation in activities of daily living was rated 0.19 (95% confidence interval [CI] 0.13, 0.25), tolerance of onl y bed-to-chair ambulation 0.17 (95% CI 0.11, 0.23), and permanent nursing h ome placement 0.16 (95% CI 0.10, 0.22). Bivariate analysis identified femal e gender and African-American race as predictors of higher utility scores ( p less than or equal to .05). In multiple regression analysis, only race re mained statistically significant (p less than or equal to .02 for all three outcome variables). CONCLUSION: Comparisons of African-American values with those of whites con cerning defined states of debility demonstrate greater than threefold incre ases in utility scores. This finding suggests that racial differences need to be taken into account when studying the effects of medical interventions on quality of life.