More bad news about racial disparities in healthcare
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Many studies have documented the fact that patients of color are less likely to receive the same quality of medical care as whites, and that those differences often translate to worse health outcomes. The pattern holds up even after taking into account demographic factors such as income, education and health insurance status.
To figure out why this is, a group of researchers from Yale University’s School of Public Health and the Urban Institute focused on 133,821 patients who were treated for one of 10 surgical procedures at hospitals in New York City or the adjacent counties of Westchester (to the north) and Nassau (to the east) between 2001 and 2004.
The researchers picked New York City because of its diversity of ethnic groups and abundance of hospitals. They picked the 10 procedures – for breast cancer, colorectal cancer, gastric cancer, lung cancer, pancreatic cancer, coronary artery bypass graft, angioplasty, abdominal aortic aneurysm repair, carotid endarterectomy and total hip replacement – because prior studies have shown that surgeons and hospitals who perform them more often produce better outcomes.
The study, published Monday in the journal Archives of Surgery, found that, “For all 10 procedures, white patients were more frequently treated by both high-volume hospitals and surgeons than were black, Asian and Hispanic patients.
”Averaging all procedures together, white patients benefited from both high-volume hospitals and high-volume surgeons in 37.6% of cases, compared to 20.6% of cases for black patients, 24.4% of cases for Asian patients, and 25.5% of cases for Latino patients, according to the study.
When the researchers took demographic and health variables into account, they found that blacks were less likely than whites to be treated by high-volume surgeons in high-volume hospitals in nine out of the 10 categories. The corresponding figure for Asians was five out of 10 categories, and for Latinos it was four out of 10, the study found.
The results showed a “persistent pattern” of racial disparities that “play out differently for different minority groups,” the authors wrote. But the study “does not support the common suggestion that health care disparities are driven primarily by differences in socioeconomic status,” they added. For instance, Asians were most likely to be either uninsured or on Medicaid, although they came from neighborhoods with higher socioeconomic status than blacks or Latinos.
Also, for half of the procedures, some racial groups got the same treatment as whites while others did not. That suggests that different factors may be at work for each minority group and each kind of health problem, they wrote. But the researchers weren’t able to pinpoint what those causes were. They did have some ideas, though.
Although New York City is a melting pot, it also anchors one of the five most segregated metropolitan areas in the country, according to U.S. census data. On top of that, only 9.5% of surgeons and 22% of hospitals in the study were classified as “high-volume,” and those hospitals may be clustered in neighborhoods populated by whites, they wrote. (To test this theory, it would be useful to see whether white and minority patients treated in a given hospital were equally likely to be treated by a high-volume surgeon.)
Another theory is that white patients are more likely to be referred to high-volume hospitals and surgeons because they “have access to better-informed referral networks,” the researchers wrote. But New York state has tried to even the playing field by publishing “report cards” on hospitals and surgeons. Since the program began in 1991, more black patients have been going to higher-quality surgeons for coronary artery bypass grafts, though the levels are still lower than for whites.
-- Karen Kaplan
