Racial Health Care Disparities Continue Despite Some Improvements, Study Finds
While some improvements have been made in health care equality among black and white U.S. residents, significant disparities remain for black patients, including less access to operations, tests, medications and other treatments, according to three studies published Thursday in the New England Journal of Medicine, the Washington Post reports.
The studies were conducted to evaluate efforts by local, state and federal health agencies; medical organizations; and private foundations to close racial gaps in health care. The studies include only black and white patients because reliable data for other minorities were unavailable, according to the Post.
In the first study -- led by Ashish Jha, an internist and assistant professor at the Harvard School of Public Health -- researchers analyzed data on the 30 million patients enrolled in Medicare annually from 1992 to 2001 to see how often patients received nine of the most common surgeries.
The study found that by 2001 the gap in care between whites and blacks had narrowed only in the rates of one operation for each gender: repairing abdominal aortic aneurysms in men and performing angioplasties in women, which was "a disparity that disappeared entirely," the Post reports. The treatment gaps did not narrow for heart bypasses and valve replacements, and they increased for back surgeries, carotid endarterectomies to prevent strokes, hip replacements, knee replacements and appendectomies.
Researchers also found that no U.S. region had significantly equalized care for bypass surgery, endarterectomy and hip replacement for black patients.
The study is available online.
In the second study, researchers from Emory University, led by Viola Vaccarino, studied hospital records of 598,911 heart attack patients at 658 hospitals between 1994 and 2002. The study found that black patients were much less likely than whites to get basic diagnosis tests, clot-busting drugs or angioplasties (Stein, Washington Post, 8/18).
According to the study, the use of aspirin and beta-blocker drugs was not significantly different between whites and blacks. However, black males and females were less likely than white patients to have angiograms, which detect blocked blood vessels, or procedures to restore blood flow. Black women had the highest death rates in the study, researchers found (Bell/Minaya, Baltimore Sun, 8/18).
The study found that 86.5% of white men received clot busters or angioplasty, compared with 77.8% black women (Smith, Boston Globe, 8/18).
Vaccarino said, "The more invasive the procedure was, the more difference we found" (Donn, AP/Las Vegas Sun, 8/18).
The study is available online.
In the third study, lead researcher Amal Trivedi and colleagues from Harvard Medical School analyzed data on 1.5 million Medicare patients in 183 managed care plans from 1997 to 2003 (Washington Post, 8/18).
The federal government in 1997 began requiring managed care plans to measure and report on their performance (AP/Las Vegas Sun, 8/18). Researchers looked at nine measures of quality of care, such as whether women received mammograms or whether diabetic and heart patients received basic tests and treatments.
They found that overall quality improved for both races. The treatment gap narrowed for seven of the measures, according to the study. On five of those measures, the disparity in treatment between white and black patients was less than two percentage points.
However, the gap was not eliminated for any of the measures and widened for two: fewer diabetic blacks had their blood sugar properly controlled and fewer black heart patients lowered their cholesterol, according to the study (Washington Post, 8/18). The study found that managed care patients of both races were substantially more likely to receive disease screenings in 2003 compared with 1997, and both races were equally likely to get the tests by 2003 (Boston Globe, 8/18).
The largest improvement was an 11 percentage point increase in the number of blacks who met standards for being prescribed beta blockers. By the end of the study, treatment for 93% of black patients met the standards of care, compared with 94% of white patients, researchers found (AP/Las Vegas Sun, 8/18).
According to the Post, experts said the third study shows that "some care did improve for blacks when the government put pressure on health plans and doctors by requiring them to report whether they were meeting certain minimum standards" (Washington Post, 8/18).
The study is available online.
Thomas LaVeist, a professor of health policy and management and director of the Morgan-Hopkins Center for Health Disparities Solutions, suggested that in order to further narrow the treatment gaps, hospitals could be sanctioned if they continue to provide unequal care. He said that fines could be levied against such hospitals by the Joint Commission on Accreditation of Healthcare Organizations, or JCAHO could withdraw accreditation if improvements aren't made (Baltimore Sun, 8/18).
Other possible solutions to narrow the gap include providing universal health care coverage, compiling more data on race, increasing awareness of disparities, and making improvements to the medical system by, for example, linking hospital and doctor reimbursements to quality of care, doctors said (AP/Las Vegas Sun, 8/18).
Jha said, "We have known for 20 years that we have a problem in our health care system: that blacks and whites do not receive equal care. We had hoped all the attention paid to this topic would result in some improvement. What we found is we have not made much progress." She added, "This should be a call to action to make the changes needed to make sure people get equal care."
David Williams of the University of Michigan said, "These persistent disparities are saying that systemically, based on an individual's skin color, Americans are still treated very differently by our health care system. This is clearly unacceptable, given the values of our society" (Washington Post, 8/18).
Willarda Edwards, an internist and president of the Maryland State Medical Society, said, "I'm not very optimistic about what's been going on. There hasn't been any real action on changing things" (Baltimore Sun, 8/18).
NEJM Editor Jeffrey Drazen said, "It's obvious that whatever we've been doing to resolve disparities for the past decade hasn't been working" (Boston Globe, 8/18).