Background Differences in the use of major procedures accordingto patients' race are well known. Whether national and localinitiatives to reduce these differences have been successfulis unknown.
Methods We examined data for men and women enrolled in Medicarefrom 1992 through 2001 on annual age-standardized rates of receiptof nine surgical procedures previously shown to have disparitiesin the rates at which they were performed in black patientsand in white patients. We also examined data according to hospital-referralregion for three of the nine procedures: coronary-artery bypassgrafting (CABG), carotid endarterectomy, and total hip replacement.
Results Nationally, in 1992, the rates of receipt for all theprocedures examined were higher among white patients than amongblack patients. The difference between the rates among whitesand blacks increased significantly between 1992 and 2001 forfive of the nine procedures, remained unchanged for three procedures,and narrowed significantly for one procedure. We examined ratesof CABG, carotid endarterectomy, and total hip replacement in158 hospital-referral regions (79 hospital-referral regionsfor black men and white men and 79 for black women and whitewomen) with an adequate number of persons for each procedure.We found that in the early 1990s, whites had higher rates forthese procedures than blacks in every hospital-referral region.By 2001, the difference between whites and blacks (both menand women) in the rates of these procedures narrowed significantlyin 22 hospital-referral regions, widened significantly in 42,and were not significantly changed in the remaining hospital-referralregions. At the end of the study period, we found no hospital-referralregion in which the difference in rates between whites and blackswas eliminated for men or women with regard to any of thesethree procedures.
Conclusions For the decade of the 1990s, we found no evidence,either nationally or locally, that efforts to eliminate racialdisparities in the use of high-cost surgical procedures weresuccessful.
Source Information
From the Department of Health Policy and Management, Harvard School of Public Health (A.K.J., Z.L., A.M.E.); the Division of General Medicine, Brigham and Women's Hospital (A.K.J., E.J.O., A.M.E.); and the Boston Veterans Affairs (VA) Health System (A.K.J.) — all in Boston; and the Outcomes Group, White River Junction VA Medical Center, White River Junction, Vt., and Dartmouth Medical School, Hanover, N.H. (E.S.F.).
Trends in Racial Disparities in Care
Kuller L. H., Freedman B. I., Wagenknecht L. E., Bowden D. W., Keppel K. G., Pearcy J. N., Weissman J. S., Akpunonu B. E., Mutgi A. B., Khuder S. A., Vaccarino V., the National Registry of Myocardial Infarction Investigators , Jha A. K., Epstein A. M., Orav E. J., Trivedi A. N., Zaslavsky A. M., Ayanian J. Z.
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N Engl J Med 2005;
353:2081-2085, Nov 10, 2005.
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