Surgery, chronic care are worst in racial health gap

Three studies show some progress on black-white health disparities since the early 1990s, but the gaps are far from gone.

By Kevin B. O'Reilly, AMNews staff. Sept. 12, 2005.

More than 600 peer-reviewed studies in the last two decades have documented the black-white disparity in health care, and the results have spurred politicians, bureaucrats and doctors into a number of efforts aimed at eliminating or at least narrowing the gap.

Three new studies published in the Aug. 18 New England Journal of Medicine attempted to track data over time to see how these efforts have panned out. The results: Although black-white disparities narrowed for some areas of relatively simple care, when it comes to surgical treatments and care of chronic conditions, the gaps have remained and in some cases actually have widened.

"The reality is that on many grounds, we don't see much changing," said Ashish K. Jha, MD, MPH, lead author of one of the studies and a professor of medicine at the Harvard School of Public Health. "The efforts we've made in the past have not been successful."

Dr. Jha's study measured how often black and white Medicare beneficiaries with the same diagnosis received one of nine high-cost surgical procedures between 1992 and 2001 and concluded that disparities widened for five, narrowed for one and went unchanged for three.

Dr. Jha and his co-authors also studied the rates of coronary artery bypass grafting, carotid endarterectomy and total hip replacement in 158 hospital-referral regions and found that although disparities narrowed in 22 of the regions, the gaps widened in 42 and were unchanged in the rest.

"We found that a given region might improve on its hip replacement rates, but the other rates seemed to widen," Dr. Jha said. "There was no consistent trend toward improvement, and in no area did the gap for procedures go away."