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Racial disparities in care for the elderly persisted and even worsened for some procedures in the late 1990s

Despite a 1996 Department of Health and Human Services initiative to eliminate disparities in care, racial disparities in elderly care persisted and even worsened for some procedures during the late 1990s, reveals a new study. Jayasree Basu, Ph.D., M.B.A., of the Agency for Healthcare Research and Quality (AHRQ), and Lee R. Mobley, Ph.D., of RTI International, analyzed discharge data for New York and Pennsylvania hospitals for elderly patients undergoing three referral-sensitive hospital procedures during 1997 and 2001 using the Healthcare Cost and Utilization Project State Inpatient Database.

Percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass graft surgery (CABG), and hip/joint replacement are fairly discretionary, high-technology procedures that generally require a referral from a primary care physician to a specialist. Elderly blacks were 37 percent less likely than elderly whites to have received PTCA in 1997, but were 48 percent less likely to have had this procedure in 2001, when compared with marker admissions (non-referral-sensitive urgent). Likewise, blacks were 35 percent and 49 percent less likely than whites to have received CABG in 1997 and 2001, respectively, compared with marker admissions.

The disparities in CABG use between whites and other races (those who were not black or Hispanic) were not significant in either year. Also, there were no differences in CABG or PTCA rates for Hispanics versus whites in 1997, but in 2001 Hispanics were 34 percent less likely to have undergone PTCA than whites.

The differences between Hispanics and whites were not significant for hip/joint replacement in either year. The elderly from racial groups other than blacks and Hispanic also showed greater disparities in care for these three procedures compared with elderly whites over time.

While they were 39 percent more likely than whites to have received PTCA in 1997, the difference became nonsignificant in 2001. Also, the members of this elderly subgroup were 24 percent less likely to undergo hip/joint replacement in 1997, but were 46 percent less likely to undergo the procedures in 2001.

The authors explained that these findings may be consistent with expectations for the post-Balance Budget Act period with significant financial constraints and Medicare managed care plan disruptions that could have affected minorities more.

See "Trends in racial disparities among the elderly for selected procedures," by Drs. Basu and Mobley, in Medical Care Research and Review, May 19, 2008. Reprints (AHRQ Publication No. 08-R074) are available from the AHRQ Publications Clearinghouse.

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