August 17, 2005

Studies find racial differences in US health care

By Gene Emery

BOSTON (Reuters) - Racial disparities still exist in U.S.
medical care despite years of attempts to reduce them, with
black women typically being the least likely to get the care
they need, research published on Wednesday shows.

"For most of the areas studied, disparities between white
patients and black patients have not substantially improved
during the past decade or so," said Nicole Lurie in an
editorial in The New England Journal of Medicine, where the
findings appear.

Lurie of the Rand Corp. said there was hope for improvement
because the leaders of insurance plans covering 90 million
people "now understand that in order to make further
improvement in the quality of health care and respond to a more
demographically diverse marketplace, they need to make progress
in racial disparities."

A study led by Amal Trivedi of Brigham and Women's Hospital
in Boston contained a glimmer of good news, showing that racial
disparities for patients in managed care plans had declined in
seven out of nine categories from 1997 to 2003.

"When you have programs that provide more consistency for
everyone, that seems to have some effect on racial
disparities," Ashish Jha of the Harvard School of Public
Health, author of one of the other studies, told Reuters.

But the other research was less encouraging.

The Jha team found that the racial disparities for five
procedures, such as surgery to replace a hip, knee or heart
valve, actually increased between 1992 and 2001.

The gap in care for blacks narrowed for only one of the
nine procedures studied.

"When we started our study two years ago, we did it with
the hope that we would find a few procedures where the gap was
narrowing, or a few regions around the country where the gap
truly got eliminated so we could try to extrapolate that to the
rest of the country," Jha said. "We couldn't find any place in
the country, or any set of procedures, where we could
consistently see the gap narrowing."

"It's a little shocking," he said.

The third study came to a similar conclusion.

Using data from a national heart attack registry,
researchers found that between 1994 and 2002, for every 100
white men who needed and received treatment to have their
narrowed heart arteries reopened, the same care was received by
97 white women, 91 black men and 89 black women.

Similar trends were found for both the likelihood of
receiving coronary angiography, where doctors locate specific
blockages in the heart, and the risk of death in hospital
following a heart attack.

There was "no evidence that the differences have narrowed
in recent years," said Viola Vaccarino of Emory University
School of Medicine. "We could not determine the reasons for the
differences," Vaccarino said.

However, the disparities were not seen across the board.
Blacks and whites were just as likely to receive aspirin and
beta-blocker drugs for their heart disease, for example.

More than 600 studies in the medical literature have shown
over the years that the quality of care varies according to a
person's racial or ethnic background.