March 3, 2009
12:01 a.m. Eastern Time
African American Heart Attack Patients Are Disproportionately Likely
To Be Admitted To High-Mortality Hospitals
In Highly Segregated Areas, Blacks Are More Likely Than Whites To Be Admitted
To Hospitals With Poor Survival Rates, Even When Better Hospitals Are Closer
Bethesda, MD -- African American heart attack victims who live in racially segregated areas are disproportionately likely to be admitted to hospitals with higher-than-average mortality rates, even when the hospital closest to them has lower mortality rates, according to a new study published today on the Health Affairs Web site. The study suggests that eliminating health care disparities will likely require addressing the social factors that lead to segregation. http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.2.w368
Researchers looked at hospital admissions of Medicare enrollees for acute myocardial infarctions, or heart attacks, in 118 health care markets over the period 2000-2005. They found that blacks were 35 percent more likely than whites to be admitted to hospitals classified as "high mortality," in which relatively high percentages of heart attack patients did not survive: 45 percent of African American patients were admitted to such hospitals, as compared to only 33 percent of white patients.
They examined the effects on admission patterns of segregation levels, as measured by both levels of residential segregation and levels of segregation in admissions at area hospitals. "These two measures of segregation tracked closely, which suggests that hospitals are segregated largely because they reflect the residential areas they serve," said lead author Mary Vaughan Sarrazin, an investigator at the Iowa City Veterans Affairs Medical Center.
However, Sarrazin and her colleagues found that the story was more complicated than that. In highly segregated areas, blacks were more likely than whites to be admitted to high-mortality hospitals even when there was a closer hospital with better survival rates. "This finding is striking, since patients suffering from heart attacks are typically directed to the closest hospital," Sarrazin said.
For example, in areas with high levels of hospital segregation, 27 percent of blacks who lived closest to a hospital not classified as high mortality nevertheless were admitted to a high-mortality hospital farther away. In comparison, only 9 percent of whites in a similar situation were admitted to a high-mortality hospital. By contrast, this difference in admission patterns was not present in less segregated areas. In areas with low levels of hospital segregation, 14 percent of white and 15 percent of black patients living closest to a hospital not classified as high mortality nevertheless ended up in a high-mortality hospital.
The researchers suggest several possible explanations for their findings. For instance, "blacks living in highly segregated areas may feel unwelcome in majority white hospitals, even if such hospitals are accessible," write Sarrazin and coauthors Mary Campbell and Gary Rosenthal of the University of Iowa. They also note that black patients are more likely than their white counterparts to be treated by black physicians, who in turn are more likely to practice in hospitals with a tradition for caring for black patients. Blacks are also more likely to use hospital emergency departments as a usual source of care, which may limit physician referrals to higher-quality hospitals, the researchers point out.
"Sanctioned segregation of hospitals was eliminated in the 1960s, but de facto segregation remains," Sarrazin and her colleagues write. They conclude: "Our findings suggest that eliminating racial disparities in health care may require policies that consider entrenched social factors driving racial segregation."
After the embargo lifts, the article by Sarrazin and coauthors will be available at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.2.w368
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