Hospital access explains 53% of racial disparities

It's common knowledge that there are racial disparities in healthcare quality, but researchers have struggled to understand the specific reasons for them. However, a new study published in JAMA Surgery explains that for coronary artery bypass graft (CABG) procedures, the disparity is due in large part to unequal access to high-quality hospitals.

The researchers, led by Govind Rangrass, M.D., of the University of Michigan, Ann Arbor, analyzed Medicare data for 173,925 CABG patients, 8.6 percent of whom were nonwhite. While the mortality rate for the entire research population was 3.6 percent, among nonwhite patients, there was a 34 percent increased risk of death, according to the study.

Looking further into the data, the researchers found that the portion of hospitals with the highest proportion of nonwhite patients also had the greatest risk-adjusted mortality rate for patients of all races--3.8 for white patients and 4.8 percent for nonwhite. Meanwhile, the third of hospitals with less than 2 percent nonwhite patients had risk-adjusted mortality of 3.2 percent for white patients and 3.7 percent for nonwhite patients.

Adjusting for other factors like hospital quality and socioeconomic status, the researchers were able to account for a slim majority of the disparity, 53 percent. "However, even after these factors were taken into account, nonwhite patients had a 16 percent higher mortality," the study noted.

The researchers speculated that the unexplained portion of the disparity could be due to nonwhite patients seeking care at later, direr stages of disease, proximity to quality hospitals, racially segregated referral patterns or regional hospital quality disparities. "With a better understanding of the barriers to high-quality care, we will be able to design more effective programs to decrease health disparities," they wrote.

A study in late 2012 found that when black patients were given a questionnaire about their personal values in the waiting room, they requested--and were given--more information, indicating a potential solution to racial disparities in care, FiercePracticeManagement previously reported.

To learn more:
- here's the study abstract