Wide Disparities in Health Care by Race and Region

Race and place of residence can have a staggering impact on the course and quality of the medical treatment a patient receives.

According to new research showing that blacks with diabetes or vascular disease are nearly five times more likely than whites to have a leg amputated, and that women in Mississippi are far less likely to have mammograms than those in Maine.

The study, by researchers at Dartmouth, examined Medicare claims for evidence of racial and geographic disparities, and found that on a variety of quality indices, blacks typically were less likely to receive recommended care than whites within a given region.

But the most striking disparities were found from place to place.

For instance, the widest racial gaps in mammogram rates within a state were with a difference of 12% points between the white rate and the black rate. The statistics were for women ages 65 to 69 who received screening in 2004 or 2005 in Massachusetts, California, Illinois, and California.

In all but two states, black diabetics were less likely than whites to receive annual hemoglobin testing. But blacks - 66% were far less likely to be screened than those in Massachusetts and Colorado.

Disparities in the rate of leg amputations were particularly stark. The rate for blacks was about 6 per 1,000. The rates for whites in three Southern states were much lower, about 1.3 per 1,000.

Such variations may be partly explained by regional differences in education and poverty levels, but researchers increasingly believe that variations in medical practice and spending also are factors.

In health care, it’s not only who you are that matters - it’s also where you live.

The study was commissioned by the nation’s largest health-related philanthropy, the Robert Wood Johnson Foundation, which recently announced a three-year, $300 million initiative intended to narrow health care disparities across lines of race and geography. Officials said it would be the largest effort to improve health care quality ever undertaken by a charity in the United States

Dr. John R. Lumpkin, senior vice president of the foundation, said that more than a third of the $300 million would be spent to hire national experts to help regional coalitions tailor their quality improvement plans. The remainder of the money will be devoted to research, evaluation and the promotion of quality standards.

The areas selected for the grants are Cincinnati; Cleveland; Detroit; Humboldt County, Calif.; Kansas City, Mo.; Maine; Memphis; Minnesota; Seattle; south central Pennsylvania; western Michigan; western New York; Willamette Valley in Oregon; and Wisconsin.

The foundation’s endowment, now about $10 billion, was financed originally from the wealth of its namesake, who died in 1968 after building Johnson & Johnson into one of the world’s largest sellers of health and medical products.

The group has been a major force in curbing tobacco use, and has more recently turned its attention to obesity, announcing a five-year, $500 million effort on that front last year.

Source: Latinos for National Health Insurance