Health Care Inequities Caused 866,000 Deaths Among African Americans, Study Finds

Failure to deliver equal care to African Americans compared with whites resulted in an additional 886,000 U.S. deaths among African Americans between 1991 and 2000, according to a report in the December issue of the American Journal of Public Health, the Washington Post reports. The study was conducted by Steven Woolf, director of research at Virginia Commonwealth University's Department of Family Medicine; David Satcher, former U.S. Surgeon General and current director of the National Center for Primary Care at the Morehouse School of Medicine; and colleagues.

The researchers examined data from the National Center for Health Statistics and considered mortality rates -- which decreased by an average of about 0.7% annually during the study period -- to estimate the number of deaths that were prevented by improvements in the "technology of care," including better prescription drugs, devices and procedures. They found that between 1991 and 2001, age-adjusted mortality rates for white men and women were, on average, 29% and 24% lower, respectively, than for African Americans. The researchers calculated how many deaths could have been prevented if the mortality rates for whites and African Americans were equal. They estimated that technology improvements averted a total of 176,633 deaths during the study period.

The authors noted several limitations to their study, including the assumptions that racial disparities could be eliminated quickly and that deaths averted by improvements in technology and elimination of disparities are mutually exclusive, and that mortality rates can be influenced by factors other than health care, including the environment and patient lifestyles.

They also noted that the study is limited by its narrow focus on only mortality, even though "racial disparities encompass morbidity and other domains." They added, "Socio-economic conditions represent a more pertinent cause of disparities than race. An intriguing question is whether more lives are saved by medical advances or by resolving social inequities in education and income."

The authors said that more funding is needed to develop programs that work to deliver care to underserved groups, adding, "The prudence of investing billions in the development of new drugs and technologies while investing only a fraction of that amount in the correction of disparities deserves reconsideration." They added that despite the limitations of their analysis, policymakers should act now to eliminate racial disparities in health care, instead of waiting for further research to confirm the link, the Post reports.

Woolf said the findings show that "five times as many lives can be saved by correcting the disparities ... than in developing new treatments." Satcher said that some steps toward eliminating racial disparities in health care have been taken through the government's Healthy People 2010 program, but more needs to be done. He added, "Access to care is a big factor. African Americans and Hispanics are much more likely to be uninsured and underinsured and underserved. So a great part of it is really focusing on how do we get prevention programs, intervention programs (and) treatment programs to people in underserved communities."

Shiraz Mishra of the University of Maryland School of Medicine's Comprehensive Center for Health Disparities, Research Training and Outreach said that unless issues of access to care "are addressed, we will not be able to reduce disparities (between racial groups) in morbidity ... or mortality in the United States." He added, "Technological advances do have their place in our society; however, there are some things that are a little bit more basic."

Winston Price, president of the National Medical Association -- which represents African-American health care providers -- called the findings "staggering," adding that policymakers, doctors, community leaders and others need to "create an environment where the data and the best practices are communicated to the areas of need in a real-time sense, so communities where health disparities are most rampant will not need to wait ... before interventions are brought" to them. He recommended the development of outreach programs to educate racial minorities about their options for health care and about best practices (Payne, Washington Post, 12/21). An abstract of the study is available online.