The healthcare gap between blacks and whites is closing on many simple, cheap medical treatments, but deeper disparities stubbornly persist for more complex and costly procedures, new research suggests.
Three studies published today in the New England Journal of Medicine mostly compared 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. Gaps were also reduced for prescribing beta-blocker heart drugs and cholesterol testing after heart attacks. But racial disparities widened by 3 percentage points for both control of diabetics' blood sugar and of heart patients' cholesterol.
The other two studies, led by Harvard and Emory University in Atlanta, show persistent disparities in mostly expensive and elaborate procedures like some blood vessel repairs, heart and back surgeries, and joint replacements. By contrast, for a simple treatment like aspirin, blacks and whites were handled similarly.
"The more invasive the procedure was, the more difference we found," said Viola Vaccarino, M.D., who led the Emory study.
The studies weren't designed to pinpoint the precise reasons for the gaps or changes over time. But researchers said more elaborate treatments are harder to improve quickly because they involve multiple steps and resources. They may require coordination between doctors, hospitals and pharmacies.