Health Care In Black And White

Equal access to health insurance could largely close the racial gap in medical care and survival rates for blacks with heart failure, a study of nearly 30,000 Medicare patients suggests.

The study looked at Medicare because blacks and whites in the program presumably have equal health insurance. It found that blacks had slightly better survival rates; were about as likely as whites to undergo a standard diagnostic test; and were slightly more likely to receive standard medication — blood-pressure drugs called ACE inhibitors.

Previous studies have found that disease rates and quality of medical care are worse for blacks than for whites for a variety of ailments, including heart failure. Among the possible reasons given are unequal access to medical care, cultural differences and racial bias among doctors.

"Patients of color can wonder if it's even possible to get a fair shake," said Dr. Harlan Krumholz, a Yale University cardiologist.

His study found that in at least some cases, the answer appears to be yes.

"We found no evidence that people are being treated unfairly based on their race," Krumholz said.

The study differed from previous ones in some important ways, including examining a group of patients who all had health insurance.

And unlike some previous studies that found racial disparities, Krumholz said, this one did not involve complex treatments such as heart bypass.

The results appear in Wednesday's Journal of the American Medical Association.

The study involved 29,732 Medicare patients hospitalized with heart failure in 1998 and 1999.

Nearly equal numbers of blacks and whites studied — about 67 percent — underwent a standard measure of the heart's pumping strength called left ventricular ejection fraction.

ACE inhibitors, which relax blood vessels and increase blood flow to the heart, were prescribed for slightly more blacks deemed most suitable for the drugs than for whites.

Blacks also had lower death rates one month after hospitalization — 6.3 percent versus 10.7 percent for whites — and one year afterward — 31.5 percent versus 40 percent.

Dr. Clyde Yancy of the American Heart Association, an associate professor of medicine at the University of Texas Southwestern Medical Center in Dallas, cautioned that the study involved blacks who were perhaps healthier than the whites studied. He noted that the black patients generally had fewer previous heart problems.

But he said the study is "important and clearly demonstrates similarity of outcomes" when blacks and whites have equal access to health insurance.

"It now establishes an even greater mandate for equal access to care for all patients," Yancy said.

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