What If We Were Equal? A Comparison Of The Black-White Mortality Gap In 1960 And 2000

Satcher, David; Fryer, George E.; McCann, Jessica; Troutman, Adewale; Woolf, Steven H.; Rust, George

doi:10.1377/hlthaff.24.2.459

Cited by 234 publications

(166 citation statements)

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“…We therefore selected beneficiaries for whom we could demonstrate continuing use of the direct care system during the duration of the study. Study beneficiaries were identified using the following inclusion criteria: (1) Age Ͼ18 yr-old; (2) Outcomes Figure 1 shows the outcomes assessed during the study, which for purposes of uniformity are referred to collectively as targets. To avoid bias due to differences in follow-up among beneficiaries, in which beneficiaries with longer potential follow-up might have a higher frequency of outcomes, outcomes were assessed over a 12-mo period from the date of the first test used to determine the entry eGFR, but no later than the end of the study date, because it was assumed the stage of CKD during this first test would determine further medical treatment.…”

Section: Patient Populationmentioning

confidence: 99%

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Assessment of Racial Disparities in Chronic Kidney Disease Stage 3 and 4 Care in the Department of Defense Health System

Gao

Oliver

Das

et al. 2008

Clinical Journal of the American Society of Nephrology

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Background and objectives: Racial disparities in provision of healthcare are widespread in the United States but have not been specifically assessed in provision of chronic kidney disease (CKD) care.Design, setting, participants, & measurements: We conducted a retrospective cohort study of the clinical database used in a Department of Defense (DOD) medical system. Beneficiaries studied were DOD-eligible beneficiaries with CKD stage 3 (n ‫؍‬ 7729) and 4 (n ‫؍‬ 589) using the modified Modification of Diet in Renal Disease (MDRD)-estimated GFR formula but requiring manual correction for Black race. Compliance with selected Kidney Disease Outcomes Quality Initiative (KDOQI) CKD recommended targets (monitoring of recommended laboratory data, prescription of recommended medications, and referral to nephrology) was assessed over a 12-mo period, stratified by CKD stage. Logistic regression analysis was used to assess whether race (White, Black, or other) was independently associated with provider compliance with targets, adjusted for demographic factors and burden of comorbid conditions. Results: Among the targets, only monitoring of LDL cholesterol was significantly less common among Blacks. For all other measures, compliance was either not significantly different or significantly higher for Black compared with White beneficiaries. However, patients categorized as "Other" race were in general less likely to achieve targets than Whites, and at stage 3 CKD significantly less likely to achieve targets for monitoring of phosphorous, hemoglobin, and vitamin D.Conclusions: In the DOD health system, provider compliance with selected CKD stage 3 and 4 targets was not significantly lower for Black beneficiaries than for Whites, with the exception of LDL cholesterol monitoring. Patients classified as Other race were generally less likely to achieve targets than Whites, in some patients significantly so.

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Section: Patient Populationmentioning

confidence: 99%

“…Blacks have been shown to experience higher mortality, less access to care, higher risk of renal disease progression, fewer referrals for renal transplantation, and shorter renal allograft survival than Whites (1)(2)(3)(4)(5). Some programs aimed at enhancing access to care have shown improvements in this health gap (6,7).…”

mentioning

confidence: 99%

Assessment of Racial Disparities in Chronic Kidney Disease Stage 3 and 4 Care in the Department of Defense Health System

Gao

Oliver

Das

et al. 2008

Clinical Journal of the American Society of Nephrology

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“…Since the 1960s, the mortality rate for blacks has been 50 percent higher than that for whites, and the infant mortality rate for blacks has been twice as high as that for whites. 2,3 Health disparities exist even in health care systems that offer patients similar access to care, such as the Department of Veterans Affairs, 4 which suggests that disparities originate outside the formal health care setting.…”

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confidence: 99%

Where Health Disparities Begin: The Role Of Social And Economic Determinants—And Why Current Policies May Make Matters Worse

2011

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Health disparities by racial or ethnic group or by income or education are only partly explained by disparities in medical care. Inadequate education and living conditions-ranging from low income to the unhealthy characteristics of neighborhoods and communities-can harm health through complex pathways. Meaningful progress in narrowing health disparities is unlikely without addressing these root causes. Policies on education, child care, jobs, community and economic revitalization, housing, transportation, and land use bear on these root causes and have implications for health and medical spending. A shortsighted political focus on reducing spending in these areas could actually increase medical costs by magnifying disease burden and widening health disparities.

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“…10 One study found that closing the black-white mortality gap would eliminate a startling "83,000 excess deaths per year among African Americans." 11 …”

Section: Disparities In Health Statusmentioning

confidence: 99%

Racial and Ethnic Disparities in Health Care

Nassar¹

2005

Ann Intern Med

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The Institute of Medicine defines disparities as "racial or ethnic differences in the quality of health care that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention." Racial and ethnic minorities tend to receive poorer quality care compared with nonminorities, even when access-related factors, such as insurance status and income, are controlled.The sources of racial and ethnic health care disparities include differences in geography, lack of access to adequate health coverage, communication difficulties between patient and provider, cultural barriers, provider stereotyping, and lack of access to providers. In addition, disparities in the health care system contribute to the overall disparities in health status that affect racial and ethnic minorities. Why is it Important to Correct These Disparities?The problem of racial and ethnic health care disparities is highlighted in various statistics:• Minorities have less access to health care than whites. The level of uninsurance for Hispanics is 34% compared with 13% among whites.• Native Americans and Native Alaskans more often lack prenatal care in the first trimester.• Nationally, minority women are more likely to avoid a doctor's visit due to cost.• Racial and ethnic minority Medicare beneficiaries diagnosed with dementia are 30% less likely than whites to use antidementia medications.ACP is strongly committed to advocating for increased access to quality health care for all, regardless of race, ethnicity, socioeconomic status, or other factors. Accordingly, the mission of ACP is "to enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine." The College believes that racial and ethnic disparities in health care are unacceptable and supports policies that increase access to health care for all, invest in preventive care, create a more diverse health care workforce, address social determinants of health, and expand research into the causes and solutions regarding racial and ethnic health disparities. Key Findings and Recommendations from the Paper ACP recommends the following:• Providing all legal residents with affordable health insurance is an essential part of eliminating racial and ethnic disparities in health care.• All patients, regardless of race, ethnic origin, gender, nationality, primary language, socioeconomic status, sexual orientation, cultural background, age, disability, or religion, deserve high-quality health care.• As our society increasingly becomes racially and ethnically diverse, physicians and other health care professionals need to acknowledge the cultural, informational, and linguistic needs of their patients. Health literacy among racial and ethnic minorities must be strengthened in a culturally and linguistically sensitive manner.• Physicians and other health care professionals must be sensitive to cultural diversity among patients and recognize that preconceived perceptions of minority patients may play a role in their...

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What If We Were Equal? A Comparison Of The Black-White Mortality Gap In 1960 And 2000

Cited by 234 publications

References 7 publications

Assessment of Racial Disparities in Chronic Kidney Disease Stage 3 and 4 Care in the Department of Defense Health System

Assessment of Racial Disparities in Chronic Kidney Disease Stage 3 and 4 Care in the Department of Defense Health System

Where Health Disparities Begin: The Role Of Social And Economic Determinants—And Why Current Policies May Make Matters Worse

Racial and Ethnic Disparities in Health Care

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