Race gap lingers in medical treatment

From 1999-2001 in city, blacks in Medicare less likely to get heart bypass

August 18, 2005|By Julie Bell and Mariana Minaya | Julie Bell and Mariana Minaya,SUN STAFF

Despite years of effort to narrow a troublesome gap in medical treatment, disparities between that for white and minority patients persist, and in some cases are widening, according to studies released today.

Experts have long-standing theories to explain the differences - ranging from cultural barriers to lack of insurance to a shortage of minority physicians. They've also shown that minorities are less likely to get important care than whites even when they have similar incomes and access to care.

But until now, few researchers have measured how efforts to narrow the gap have fared over time. The most recent results, laid out in two studies in today's New England Journal of Medicine, indicate limited improvements in the case of some treatments and growing disparities in others.

A third study showed that merely tracking the type of care that patients receive can help narrow the racial gap over time.

One of the three major studies showed that black Medicare recipients were less likely to get nine kinds of potentially life-saving or life-altering surgery than whites, even when overall medical needs were the same.

The gap grew significantly from 1992 to 2001 for five of those procedures, in both men and women - back surgeries, heart valve replacements, hip and knee replacements and appendectomies, researchers said.

The gap narrowed for only one procedure in men: surgery to repair an abdominal aortic aneurysm, a potentially life-threatening bulge in the major artery that carries blood from the heart to the rest of the body. Results in women were similar.

In Baltimore, black men enrolled in Medicare were about 63 percent less likely than white counterparts to have heart bypass surgery between 1999 and 2001, the last years of the study. Black women were 30 percent less likely than white women to have the procedure.

Those results are especially striking because blacks have higher rates of cardiovascular disease than whites (The study classified the nonblack population as "white," even though 5.5 percent were members of other races or ethnic groups).

`A wake-up call'

"To me, what it says is, we really need to redouble efforts, because at the end of the day, such huge differences in care between blacks and whites should not be acceptable," said Dr. Ashish K. Jha, an internist and assistant professor at the Harvard School of Public Health who led the Medicare study. "This really feels like a wake-up call to try to figure out where we go next to get more people involved in this struggle."

Those findings were echoed by a second study showing that rates of certain heart attack treatments varied by race and sex, with no evidence that differences have narrowed in recent years.

Researchers from Emory University, Yale University, Genentech (a San Francisco-based biotechnology company) and other institutions used a national registry of heart attack patients between 1994 and 2002 to examine gender and racial differences. They looked at patients deemed "ideal" candidates for various treatments - such as the use of aspirin, beta blocker drugs and procedures to open blocked vessels and restore blood flow to injured heart muscle. They also examined death rates.

Their findings: Use of aspirin and beta blocker drugs weren't significantly different by race and sex. Blacks of both sexes, however, were less likely than whites to have angiograms - examinations to detect blocked blood vessels - as well as procedures to restore blood flow. Death rates were highest among black women.

Mixed reactions

Medical experts had mixed reactions to the findings. Some predicted that the studies would encourage change. Others were dismayed.

"I'm not very optimistic about what's been going on," said Dr. Willarda V. Edwards, an East Baltimore internist who is president of MedChi, Maryland's medical society, and active in the National Medical Association, which represents black doctors .

Edwards said she's pressed the state organization to make racial disparities a priority but is discouraged by a lack of results across the country. "There hasn't been any real action on changing things," she said.

Four organizations sponsored by the state and federal governments as well as Maryland's two largest universities have developed programs to address racial disparities. Besides conducting research, they promote cultural sensitivity training for physicians and help minority senior citizens make the best use of their health plans, determine what tests they need and decide what questions to ask their doctors.

While the results are alarming, the Medicare study could inspire others to find out why the gaps persist, said Dr. Claudia Baquet, director of the University of Maryland School of Medicine's Center for Health Disparities.

"The academic health centers are going to tease out what are the factors and what are the reasons and what are the solutions," Baquet said. "I'm optimistic in Maryland."

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