Racial Disparities in Healthcare Within a Medicare Population

Even among the Medicare population, where access to care should be
more uniform, racial disparities in care exist.  The importance of
documenting and acting on these disparities is emphasized.  Vote No on
Prop 54 Tuesday.


Daily Health Policy Report, Oct 02, 2003

Rates of Knee Replacement Surgery
Vary in Medicare Population
by Race, Gender, Study Indicates


Rates for total knee replacement surgery in the Medicare population
vary significantly by race, ethnicity, region and gender, according to
a study published Thursday in the New England Journal of Medicine,
Long Island Newsday reports.
http://www.newsday.com/news/health/ny-hsknee023477490oct02,0,7114578.s
tory?coll=ny-health-headlines


Researchers from Dartmouth Medical School examined 430,726 Medicare
fee-for-service claims for the procedure, known as arthroplasty, filed
between 1998 and 2000. They found that black men, independent of
region, were the least likely to receive the surgery, which is the
most commonly performed joint replacement operation in the country.

The study found that 4.82 white men per every 1,000 received knee
replacements, while 3.46 Hispanic men and 1.84 black men per 1,000
received the surgery.

It also found that the operation is performed more in some regions
than in others, with the Midwest, for example, having a higher rate
than the Eastern seaboard (Ricks, Long Island Newsday, 10/2).

Despite blacks' and Hispanics' lower arthroplasty rates, those groups
generally have higher rates of osteoarthritis, the degenerative
disease that is the prime reason people undergo the procedure (Skinner
et al., New England Journal of Medicine, 10/2). An abstract of the
study is available online.

Editorial

In an accompanying NEJM editorial, Robert Wood Johnson Foundation
President and CEO Dr. Risa Lavizzo-Mourey and James Knickman, RWJF's
vice president for research and evaluation, recommend three steps to
follow up on the study:

identifying "effective, practical approaches" that providers can use
to reduce disparities;

having providers, insurers and payers measure racial and ethnic
disparities within the populations they treat; and

having more timely data collection.

Lavizzo-Mourey and Knickman conclude that the study "helps us to
understand what we do and do not know," but "what is needed most right
now is a comprehensive set of steps for action ... to set the nation
on a path that will eliminate these disparities in health care"
(Lavizzo-Mourey/Knickman, New England Journal of Medicine, 10/2)

An abstract of the editorial is available online.
http://content.nejm.org/cgi/content/short/349/14/1379


 = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = =


Newsday(Long Island, NY), October 2, 2003

Surgery's Racial Divide Study: Fewer black men have knees replaced
By Delthia Ricks STAFF WRITER
Rates of total knee replacement surgeries vary significantly by race,
ethnicity and gender, with black men the least likely to undergo the
operation, even when it's needed, researchers report today.

For years researchers have focused on heart disease treatment as a
barometer of how equally medical care is distributed among populations
nationwide. But a Dartmouth Medical School team focused on a surgery
that affects mobility and found disparities there.

"To me, this is a mystery," said Jonathan Skinner, co-lead
investigator, who studied 430,726 Medicare fee-for-service claims
between 1998 and 2000. "A fair number of people for whom a knee
replacement is medically appropriate are not receiving the
operations." Nationally, about 200,000 arthroplasties - total knee
replacements - are performed annually.

It is the most commonly performed joint replacement operation in the
country.

The operation's prime reason is osteoarthritis, the type of
wear-and-tear disease that increases with age. Generally, more knee
replacements are performed among women than men, mostly because women
are more likely to be diagnosed with arthritis, Skinner said. But even
when adjusting for that fact, the study still found disparities across
racial, geographic and gender lines.

"We know that blacks have more degenerative [arthritic] disease than
whites and we know that of the 70 million Americans who have arthritis
and chronic joint pain, 32 percent are black," said the co-principal
investigator, Dr. James Weinstein. "And yet in every region of this
country, black males were far below the norm for having this surgery."

The study found 4.82 white men per 1,000 got total knee replacements,
followed by 3.46 Hispanic men and 1.84 black men. Skinner said the
percentages are statistically significant because of the vast number
of operations performed and federal projections that more will be
performed in the future.

Region also played a role. The operation is performed more often in
some parts of the country than in others. For example, there are more
arthroplasties in the Midwest than along the Eastern seaboard. Fewer
people, regardless of race, received total knee replacements in
Manhattan, where 2.0 procedures are performed per 1,000, than in St.
Louis, where 7.2 per thousand occurred.

Doctors usually recommend arthroplasty when arthritic pain persists
and medications no longer relieve discomfort or swelling. Skinner
added that in some instances, patients may not want surgery or may not
understand the physician's recommendations.

But even in regions with lower arthroplasty rates, disparities were
still evident. On Long Island, 1.4 blacks per 1,000 - regardless of
gender - underwent the operation, compared with 2.6 whites.

 = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = =


A quote from the March 2002 report "Unequal Treatment" from the
Institute of Medicine


"Standardized data collection is also critically important in efforts
to understand and eliminate racial and ethnic disparities in
healthcare. Data on patient and provider race and ethnicity would
allow researchers to better disentangle factors that are associated
with healthcare disparities, help health plans to monitor performance,
ensure accountability to enrolled members and payors, improve patient
choice, allow for evaluation of intervention programs, and help
identify discriminatory practices."


The report:
http://www.iom.edu/includes/dbfile.asp?id=4175


 = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = =

For a formatted version of "Who is Ward Connerly" (Prop 54's author),
showing his connections to the attack on affirmative action, the
Contract with American, racist publications, school vouchers, and many
other parts of the "Reagan Revolution":
http://home.comcast.net/~mlyon01/articles/connerly.doc