Disparities in the course of disease are sometimes larger than the disparities in the incidence of illness.165 Thus, timely and appropriate therapeutic care can make a major contribution to reducing social disparities in the progression of disease. Considerable evidence suggests that there are large racial differences in the quality and intensity of medical care with blacks and other minorities receiving fewer medical procedures and poorer quality medical care than whites even after SES is considered. An Institute of Medicine report documented a pervasive pattern of racial differences in the quality and intensity of care that persisted even when even when differences in health insurance, SES, stage and severity of disease, co-morbidity, and the type of medical facility were taken into account.166 It is likely that similar patterns exist by SES, but since racial identifiers are much more likely to be on patient records than SES, our knowledge of SES differences in the quality and intensity of care is more limited.
