Exploring the role of racial/ethnic patient-physician concordance in optimizing health and patient outcomes among black populations in the United States: an integrative systematic review.

内容摘要

Black populations in the United States experience disproportionately high burdens of morbidity and mortality across numerous health outcomes. However, substantial heterogeneity exists within these populations with respect to migration history, socioeconomic context, social determinants of health, and healthcare experiences. For analytic clarity, this review distinguishes Foundational Black Americans (FBAs)-defined here as U.S.-born Black Americans descendant from US chattel slavery-from Black immigrant populations, including Afro-Caribbean and African immigrants. Disaggregation of broad racial categories is increasingly recognized as an important epidemiologic strategy for improving measurement precision and identifying population-specific determinants of health. This integrative systematic review examined whether physician-patient racial/ethnic concordance is associated with healthcare communication, trust, satisfaction, shared decision-making, healthcare utilization, adherence, and clinical outcomes among Black populations in the United States. Structured searches of PubMed and Web of Science identified studies published between 2015 and 2026. Following screening and duplicate removal, 31 studies met inclusion criteria. Communication and trust were the most frequently examined domains (14/31 studies), followed by patient satisfaction and engagement (9/31), clinical outcomes (8/31), healthcare utilization and adherence (6/31), and workforce representation (3/31). Across the literature, most studies reported at least one favorable association between racial/ethnic concordance and communication quality, patient trust, satisfaction, engagement, healthcare utilization, adherence, or selected clinical outcomes. Evidence was strongest for interpersonal and patient-experience outcomes, whereas findings for clinical outcomes were more heterogeneous and context dependent. Most included studies were observational or cross-sectional, limiting causal inference. Substantial variation in study design, exposure definitions, and outcome measurement further limited comparability across studies. Overall, physician-patient racial/ethnic concordance appears to function as one meaningful interpersonal and structural factor associated with healthcare experiences among Black populations. Workforce diversification and culturally responsive care may represent complementary strategies for improving patient engagement and reducing disparities. Future research should incorporate more refined subgroup characterization within Black populations to better understand heterogeneity in concordance-related effects.