BOSTONA new study examining health care disparities during the 1990s and up to 2001, has found that Blacks received significantly fewer surgeries that help seniors live better and longer lives compared to Whites.
The study, which was published in the New England Journal of Medicine and conducted by a research team led by Drs. Ashish Jha and Arnold Epstein of the Harvard School of Public Health, and Dr. Elliott Fisher of Dartmouth Medical School, also found that in many cases, these differences in health care are getting worse.
“For more than 20 years we have known that Black Americans receive a different level of care than Whites,” says Jha. “Despite concerted efforts to address these disparities, this study shows that Black seniors continue to receive fewer surgical procedures than Whites. On a fundamental level, these differences in care are not acceptable.”
The study — the first to look at the use of major, potentially life-saving surgeries among Black and White seniors — examined how often nine types of surgical procedures, ranging from heart bypass surgery to total hip replacement, were performed on Medicare enrollees from 1992 to 2001. The analysis shows that in 1992, White patients had higher rates for each of the nine types of procedures. By 2001, not only had the gap failed to substantially decrease in eight of the procedures, it had instead increased sharply in five: back surgeries, valve replacements, hip replacements, knee replacements and appendectomies.
“When you look at this problem of racial differences over a long period of time, you would hope to see marked reduction in the disparities between the care Black and White patients receive,” says Epstein.
“When we examined these potentially life-saving surgeries, we didn’t see any areas of the country where these disparities were eliminated.” The study is also significant because of the scope of the data analyzed. By using Medicare enrollees as the sample population, the study examined care for nearly 40 million Americans.
“Looking at these trends over time helps everyone to understand the level of effort that will be needed to address the problem of racial and ethnic disparities in care,” says Fisher. “It’s important to monitor the problem — it’s equally important to start focusing on solutions.”To view the full report, “Trends in the use of major procedures among the elderly: Are racial differences narrowing?” visit <www.content.nejm.org>.
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