Racial Health-Care Gap Closing

The stubborn gap between medical care for blacks and whites in the United States may finally be tightening.

Three large federally backed studies suggest that blacks are catching up to whites in many simple, cheap medical treatments. However, disparities persist for complex and costly procedures, and further progress may be harder to achieve.

"Things that are simpler and less expensive ... are easier fixes," said Dr. Ashish Jha of the Harvard School of Public Health, in Boston, Massachusetts. He said broad equality probably won't be reached "by small tinkering with the system."

Jha led one of the three studies published in Thursday's New England Journal of Medicine. The studies offer some of the first evidence that racial disparities in U.S. health care have narrowed, at least for some patients and treatments.

Since the 1980s, many studies have documented racial gaps in health care standards, blaming economic, cultural and even biological differences between races.

Blacks have less access to better doctors, hospitals and health plans, and the medical system treats whites and blacks differently, even when they are the same in nearly every way, research has indicated.

The new studies, examining only those two races, took into account differences such as health plans, hospitals, regions and wealth, and compared the treatment of whites and blacks by assessing how often-accepted professional standards were met for each group.

In the study finding the most equality, Harvard researchers analyzed records from 1.5 million patients in 183 Medicare managed-care plans between 1997 and 2003.

They found narrowed racial gaps for mammograms and diabetics' eye exams, blood-sugar tests, and testing and control of diabetics' cholesterol. The most dramatic improvement came in prescribing beta-blockers heart drug, for which 93 percent of blacks met standards, compared to 94 percent of whites — an improvement of 11 percentage points for blacks.

Progress wasn't apparent everywhere, though. Racial disparities widened by 3 percent for both control of diabetics' blood sugar and heart patients' cholesterol.

The other two studies, led by Harvard and Emory University in Atlanta, Georgia, show persistent disparities in mostly expensive and elaborate procedures, such as some blood vessel repairs, heart and back surgeries and joint replacements.

"The more invasive the procedure was, the more difference we found," said Dr. Viola Vaccarino, who led the Emory study. By contrast, with a simple treatment like aspirin, blacks and whites were handled similarly.

Researchers said more elaborate treatments were harder to improve quickly because they involved multiple steps and resources, and may require coordination between doctors, hospitals and pharmacies.

"Ordering a test is ... relatively easy, compared to controlling the level of cholesterol," for which "it's quite costly to take regular medicine," said Dr. Amal Trivedi, lead researcher in the managed-care study, which also suggests that better medicine can close racial gaps.

The federal government required Medicare managed-care plans in 1997 to start reporting more on performance. State and federal officials, as well as private groups, also have made efforts in recent years to track racial disparities and boost awareness.

"No one should fool anyone that this is going to happen overnight ... because the health system is so complex," added Dr. Georges Benjamin, director of the American Public Health Association.

By Jeff Donn