Examine why racial care disparities persist

Even with socioeconomic factors removed, the treatment given African-Americans may still compare poorly with that given to whites.

Editorial. May 22/29, 2000.

Our Health & Science section feature story, "A study in black & white" (AMNews, May 1) examined some well-documented disparities in care between whites and African-Americans. Such a gap is deplorable on its face alone, but new research is revealing a troubling twist to the numbers.

Socioeconomic and insurance status explain some of the differences in care -- but not all. Researchers are finding that even when such factors are removed, the treatment given African-Americans may still compare poorly with that given to whites.

"Numerous investigators have found that health insurance and socioeconomic status are the greatest predictors of access to health care, but often, they do not fully account for the observed disparities by race and ethnicity," concludes a comprehensive review of the literature since 1985, commissioned by the Kaiser Family Foundation and prepared at Morehouse School of Medicine in Atlanta.

One striking example is from a recent New England Journal of Medicine, which found that willing African-American candidates for kidney transplantation were significantly less likely to be referred for evaluation, be placed on the waiting list or be a transplant recipient within 18 months after the start of dialysis. Other disparities have been noted in cardiac care and HIV/AIDS.

The Kaiser-Morehouse report notes that the reasons for racial and ethnic disparities in care are "varied, complex, and poorly understood at this point." The raw numbers on disparities in care are the starting point, but understanding the complex factors that create them is the only way to resolve this troubling situation.

Medicine prides itself on its willingness to solve medical mysteries. How well will it embrace this one?