Racial Trends in the Use of Major Procedures among the Elderly

Ashish K. Jha, M.D., M.P.H., Elliott S. Fisher, M.D., M.P.H., Zhonghe Li, M.A., E. John Orav, Ph.D., and Arnold M. Epstein, M.D., M.A.
Recommended by Marcelo Gustavo Colominas mgcolominas@gigared.com
ABSTRACT

Background Differences in the use of major procedures according to patients' race are well known. Whether national and local initiatives to reduce these differences have been successful is unknown.

Methods We examined data for men and women enrolled in Medicare from 1992 through 2001 on annual age-standardized rates of receipt of nine surgical procedures previously shown to have disparities in the rates at which they were performed in black patients and in white patients. We also examined data according to hospital-referral region for three of the nine procedures: coronary-artery bypass grafting (CABG), carotid endarterectomy, and total hip replacement.

Results Nationally, in 1992, the rates of receipt for all the procedures examined were higher among white patients than among black patients. The difference between the rates among whites and blacks increased significantly between 1992 and 2001 for five of the nine procedures, remained unchanged for three procedures, and narrowed significantly for one procedure. We examined rates of CABG, carotid endarterectomy, and total hip replacement in 158 hospital-referral regions (79 hospital-referral regions for black men and white men and 79 for black women and white women) with an adequate number of persons for each procedure. We found that in the early 1990s, whites had higher rates for these procedures than blacks in every hospital-referral region. By 2001, the difference between whites and blacks (both men and women) in the rates of these procedures narrowed significantly in 22 hospital-referral regions, widened significantly in 42, and were not significantly changed in the remaining hospital-referral regions. At the end of the study period, we found no hospital-referral region in which the difference in rates between whites and blacks was eliminated for men or women with regard to any of these three procedures.

Conclusions For the decade of the 1990s, we found no evidence, either nationally or locally, that efforts to eliminate racial disparities in the use of high-cost surgical procedures were successful.

Source Information

From the Department of Health Policy and Management, Harvard School of Public Health (A.K.J., Z.L., A.M.E.); the Division of General Medicine, Brigham and Women's Hospital (A.K.J., E.J.O., A.M.E.); and the Boston Veterans Affairs (VA) Health System (A.K.J.) — all in Boston; and the Outcomes Group, White River Junction VA Medical Center, White River Junction, Vt., and Dartmouth Medical School, Hanover, N.H. (E.S.F.).