New research published in the June issue of the Journal of the American College of Surgeons reveals that in counties with the highest levels of segregation, an increase in the African-American or Hispanic population was associated with a decrease in the availability and use of surgical services and an increase in the number of emergency room visits. This research supports prior studies that have shown that minority groups in the United States have comparatively poorer access to a range of health care services, often resulting in late diagnosis of illness and delayed treatment.
African Americans are the most segregated racial group in the U.S. Studies have shown that segregated African-American communities have higher infant mortality rates, decreased access to appropriate cancer care and worse outcomes from organ transplantation than other racial groups experience. Both African Americans and Hispanics living in counties with a higher proportion of African-American population report that they experience difficulty obtaining health care as compared with African Americans living in counties with a smaller African-American population. Through the National Institutes of Health and Healthy People 2010, the federal government has set forth goals to explore, account for and minimize these disparities. However, despite these goals, improving access to health care continues to pose a considerable challenge to health policy makers in their attempts to establish equity in the provision of care.
“In the most segregated counties, we found that an increase as small as one percent in the African-American or Hispanic population was associated with a significant decrease in the availability and utilization of surgical services, a difference that was not present in counties with the least segregation,” said Awori J. Hayanga, MD, MPH, Administrative Chief Resident, Department of General Surgery, University of Michigan Health System. “We hope this report will guide budgetary decisions and incentives by health policy makers in their bid to close the racial health disparity gap and increase access to surgical health care across racial lines, particularly in the most segregated areas.”
A cross-sectional analysis was performed on data from the 2004 U.S. Department of Health and Human Services Area Resource File, a nationwide record of health care, economic and demographic data. Each of the 3,219 U.S. counties was categorized into one of three levels ““ most, moderately or least segregated ““ using the Isolation Index, a measure of the probability that a member of one minority group will come into contact with members of the same racial group. Multivariable linear regression analysis was performed to examine the association between access to surgical services and proportion of minority population with varying levels of segregation, adjusting for socioeconomic and health characteristics.
Results showed that in the most segregated counties, each percentage point increase in Hispanic or African-American population was associated with a statistically significant decrease in outpatient surgery volume (p< 0.0001), ambulatory surgical facilities (p< 0.0001) and number of general surgeons (p< 0.0001). In the least segregated counties, small population increases were not associated with significant decreases in surgical resources. A significant increase in the volume of emergency medical visits was associated with increasing proportions of African-American and Hispanic populations within the most segregated counties (p< 0.0001).
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