Black Americans experience stereotyping when receiving care, harming the therapeutic relationship and likely contributing to inequities in hypertension management. Although patients have described these experiences, there is limited understanding from clinicians’ perspectives. We conducted an Interpretive Description study with 30 Minnesota family medicine physicians between July and September 2023 to explore the assumptions associated with hypertensive Black patients, as perceived by the clinicians. Transcripts were analyzed and themes developed using thematic analysis with inductive and deductive approaches. Participants observed that they, or their colleagues (1) viewed Black patients as having hypertension that was more challenging to manage due to factors outside the clinicians’ control, and (2) changed their approach to Black patients’ hypertension management in response to assumed difficulty. Participants viewed Black patients as less willing and able to manage their hypertension due to mistrust and biological, behavioral, and social factors. Perceived barriers to hypertension management overlapped with what participants described as stereotypes of Black patients, and a few participants acknowledged that clinicians may convey their lower expectations of Black patients through disinvestment in their care. Participants viewed Black patients as having greater challenges with hypertension control due to factors that were seen as being indiscriminately assumed of these patients, potentially resulting in reduced clinician engagement. As such, clinicians must balance their knowledge of population-level disparities with an individualized approach to patient care. To reduce stereotyping of Black patients, it is crucial to pay closer attention to how population-level differences are discussed and applied.

Background : Black Americans have the highest prevalence of hypertension in the USA. Black immigrants, who, by definition, have time-limited exposure to the USA, may provide insight into the relationship between exposure to the US environment, Black race, and hypertension. Methods: This is a cross-sectional analysis of pooled National Health Interview Survey (2004–2017) data of foreign-born White European and Black adults (N = 11,516). Multivariable robust Poisson regressions assessed the relationship between self-reported hypertension and duration of the residency (< 5, 5–9, 10–14, ≥ 15 years) among Black, Black African, Black Caribbean, and White European foreign-born residents. Results: In multivariable analyses—controlling for age, sex, education, poverty-to-income ratio, insurance status, recent encounter with a clinician, and BMI—Black foreign-born residents (PR = 1.40, 95% CI = 1.03, 1.90) and Black Africans (10–14 years.: PR = 1.70, 95% CI = 1.13, 2.56; ≥ 15 years.: PR = 1.56, 95% CI = 1.04, 2.34) with a duration of residency of at least 15 and 10 years, respectively, had a greater prevalence of hypertension than those with duration less than 5 years. A nonsignificant positive association between a duration of residency of at least 15 years (compared to less than 5 years) and self-reported hypertension was observed for White Europeans (PR 1.49, 95% CI = 0.88, 2.51) and Black Caribbeans (PR = 1.09, 95% CI = 0.69, 1.72). Conclusion: Duration of residency is particularly associated with hypertension among Black Africans after migration to the USA. This discrepancy may be explained by differences in primary care utilization and awareness of hypertension diagnoses among recent African immigrants, along with greater stress associated with living in the USA.

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Introduction: Physicians’ perspectives regarding the etiology of racial health differences may be associated with their use of race in clinical practice (race-based practice). This study evaluates whether attributing racial differences in health to genetics, culture, or social conditions is associated with race-based practice. Methods: This is a cross-sectional analysis, conducted in 2022, of the Council of Academic Family Medicine Education Research Alliance 2021 general membership survey. Only actively practicing U.S. physicians were included. The survey included demographic questions; the Racial Attributes in Clinical Evaluation (RACE) scale (higher scores imply greater race-based practice); and 3 questions regarding beliefs that racial differences in genetics, culture (e.g., health beliefs), or social conditions (e.g., education) explained racial differences in health. Three multivariable linear regressions were used to evaluate the relationship between RACE scores and beliefs regarding the etiology of racial differences in health. Results: Of the 4,314 survey recipients, 949 (22%) responded, of whom 689 were actively practicing U.S. physicians. In multivariable regressions controlling for age, gender, race, ethnicity, and practice characteristics, a higher RACE score was associated with a greater belief that differences in genetics (β=3.57; 95% CI=3.19, 3.95) and culture (β=1.57; 95% CI=0.99, 2.16)—in but not social conditions—explained differences in health. Conclusions: Physicians who believed that genetic or cultural differences between racial groups explained racial differences in health outcomes were more likely to use race in clinical care. Further research is needed to determine how race is differentially applied in clinical care on the basis of the belief in its genetic or cultural significance.