Black Medicare beneficiaries "fare worse" than white beneficiaries "even when they belong to the same health plan," an indication that health care disparities "cannot be attributed to individual, inferior doctors," according to a study published on Wednesday in the Journal of the American Medical Association, the Boston Globe reports.
For the study, researchers at Harvard University and Brown University reviewed the medical status of more than 430,000 Medicare beneficiaries enrolled in 151 health plans from 2002 through 2004 (Smith, Boston Globe, 10/25). Researchers considered four "outcome measures" for diabetes, hypertension and heart disease (George, CQ HealthBeat, 10/24). The study found that the largest disparity in health occurred among participants who had experienced heart problems. According to the study, 72% of white participants who had experienced heart problems had their cholesterol levels under control, compared with 57% of black participants (Boston Globe, 10/25). The study indicates that racial health care disparities "cannot be attributed to high- or low-performing health plans or specific regions of the country," CQ HealthBeat reports (CQ HealthBeat, 10/24). In addition, the study indicates that the "problem of health care disparities is widespread and deeply rooted, reflecting medical, social and economic factors," the Globe reports (Boston Globe, 10/25). Such factors might include communication problems between physicians and patients and differences in the lifestyles and dietary habits of black and white Medicare beneficiaries, according to the study. However, "without further data, it would be difficult to pinpoint a cause -- and therefore difficult to determine how plans can improve treatment," CQ HealthBeat reports (CQ HealthBeat, 10/24).
Amal Trivedi, lead author of the study and an assistant professor of community health at Brown, said, "We can't say specifically why the gaps exist in each plan. It's probably a shared responsibility of plans, providers and patients. There's probably not one factor that explains all of the disparity, but health plans do play an important role" (Lee, Washington Post, 10/25). Trivedi added, "This study indicates that most health plans have substantial opportunities to improve their outcomes for African-American enrollees on these measures." Peter Bach, a senior adviser at CMS, said that the study "tells us where we need to focus, and it's exactly where we're trying to focus." Bach said, "The fact that the plans have these sorts of quality measures in place ... is really a sign they're moving" to address racial health care disparities (CQ HealthBeat, 10/24). Susan Pisano, a spokesperson for America's Health Insurance Plans, said that health insurers, physicians and hospitals acknowledge that racial health care disparities exist. She added, "What's different about today versus five or 10 years ago is that we're moving beyond just identifying that there is a problem to figuring out how we're going to solve it. This is a complicated problem, and I don't think anybody thinks there is 'the' answer" (Boston Globe, 10/25).
An abstract of the study is available online.
A separate study published on Wednesday in JAMA found that racial minorities are significantly less likely than whites to undergo major surgeries at high-volume hospitals experienced with those procedures, the Post reports. For the study, researchers at the University of California-Los Angeles David Geffen School of Medicine examined 719,608 patients who underwent one of 10 major surgeries -- such as heart bypass surgery, lung cancer surgery and knee replacement surgery -- over a five-year period (Washington Post, 10/25). The study found that black patients were less likely than white patients to undergo six of the surgeries at high-volume hospitals. In addition, the study found that Asian patients were less likely than white patients to undergo five of the surgeries at high-volume hospitals and that Latino patients were less likely than white patients to undergo nine of the surgeries at high-volume hospitals. The study also found that Medicare beneficiaries were more likely than Medicaid beneficiaries to undergo the surgeries at high-volume hospitals (Reuters/Boston Globe, 10/24). The disparities remained after researchers adjusted the results of the study for income, age and the proximity of patients to high-volume hospitals. According to the study, "inadequate transportation or the lack of knowledge among minorities about hospital quality could be factors" in the disparities, the Post reports (Washington Post, 10/25). Clifford Ko, lead author of the study, said, "Since there is significant interest among health care quality experts in improving the quality of care by directing patients to high-volume facilities, we hope that addressing key disparities may broaden receipt of care for more patients at these facilities" (Reuters/Boston Globe, 10/24). A third study published Monday in the journal Cancer found that black women who had breast cancer had lower survival rates than white and Latino women with breast cancer. For the study, researchers at the University of Texas M.D. Anderson Cancer Center in Houston examined 2,140 patients who participated in clinical trails at the center from 1975 through 2000. The study also found that black patients had more advanced cancer when they began treatment. Researchers suggest that breast cancer tumors might be more aggressive and less responsive to treatment in black women since all the women in the study received the same treatment (Washington Post, 10/25).
The hospital study is available online.
ABCNews' "Medical Minute" on Tuesday reported on the JAMA studies (McKenzie, "Medical Minute," ABCNews, 10/24). A related ABCNews story is available online.
Video of the segment is available online.