Separate studies produce conflicting results on race and gender disparities in U.S. health system

Two newly released studies in the U.S. have to some extent come to conflicting results. According to one study, by researchers at Emory University, attempts over the last decade to address race and gender disparities in the treatment of U.S. patients hospitalized for heart attacks, still in some respects raise cause for concern.

The team, in collaboration with Yale University and other U.S. institutions, found a consistent pattern of less intensive treatment offered to women and black heart-attack patients.

The study found that though heart-attack care has improved over the past decade, disparities in the use of medications and diagnostic procedures remained consistent.

The investigators studied the records of 598,911 white and black patients treated for heart attacks between 1994 and 2002 at 658 hospitals. They included only patients who were ideal candidates for therapy.

They examined differences by sex and race in the use of reperfusion therapy (the use of a drug or invasive catheter procedure to open an artery blocked by a clot); coronary angiography (a diagnostic procedure used to identify blockages in the heart's circulation); aspirin; and beta-blocker therapy.

The study found that rates of reperfusion therapy, coronary angiography and in-hospital death after heart attack varied according to race and sex.

Apparently the rate of treatments went progressively down in white women, black men and black women, compared with white men, with black women found to have the lowest use of interventions and the highest in-hospital mortality rates.

Unlike other studies showing disparities in cardiovascular treatment, this study was unique in that the changes in disparities were looked for over time.

Surprisingly it was found that differences by sex and race were as they were between 1994 and 2002.

Viola Vaccarino, MD, PhD, associate professor of medicine (cardiology) at Emory University School of Medicine and associate professor of epidemiology at Emory's Rollins School of Public Health led the multi-institutional study.

She says the disparities in treatment are of particular concern with regard to the use of reperfusion therapy and cardiac catheterization, because they could not determine the reasons for these differences.

Lower rates of treatment in patients who are clinically appropriate for treatment raise obvious concerns about under-treatment, says Vaccarino.

The authors suggest the differences reflect something about the patients or the healthcare system that have not changed over time.

Maybe women and black patients with heart attacks have less typical symptoms leading to delayed diagnosis and delayed treatment.

The socioeconomic status of the patient may also play a role, perhaps leading to lower access to specialist care, or admission to centers of poorer quality.

Nanette K. Wenger, MD, professor of medicine (cardiology) at Emory University School of Medicine and a co-author, says the findings illustrate how complex the issue is, and raises the question why these particular procedures result in race and sex differences in treatment, that is not seen with drugs. This she says is an area for further research.

Meanwhile another new study has found an increasing percentage of black enrollees in Medicare managed care plans are being screened for breast cancer or treated for diabetes or heart disease in accordance with nationally recognized quality measures.

HHS Secretary Mike Leavitt says the increased focus on preventive medicine is leading to better health for all Americans, particularly minority communities.

Researchers at Brigham and Women's Hospital and Harvard Medical School in Boston found, increased percentages of black enrollees with diabetes had accessed better monitoring of their condition.

Also the percentage of black and white enrollees prescribed a beta-blocker drug within 7 days of hospital discharge following a heart attack, heart bypass surgery, or angioplasty rose, between 1997 and 2002.

This progress resulted in many more blacks and whites getting optimal care, and also narrowed the gap from 12 percentage points to only 1 percentage point between blacks and whites with cardiovascular disease.

Blacks fell further behind whites on only one quality measure, diabetes, and having blood sugar levels controlled.

Agency for Healthcare Research and Quality (AHRQ) Director Carolyn M. Clancy, M.D. says the findings clearly show that progress is being made to reduce and eventually eliminate disparities in health care.

AHRQ is leading federal research efforts to develop knowledge and tools to help eliminate health care disparities in the United States, and produces the annual National Healthcare Quality Report and National Healthcare Disparities Report.

This second is published in the New England Journal of Medicine.

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