Disparity in health care becomes a deadly issue

The diagnosis did not get better with the second opinion. Or the third.

African-Americans, according to three studies published in Thursday's New England Journal of Medicine, still get poorer health care than whites -- fewer heart and back surgeries, fewer hip or knee replacements, fewer expensive treatments, fewer tests. Women are less likely than men to get good care, and, the researchers found, black women get the worst care of all.

"We have known for 20 years that we have a problem in our health-care system -- that blacks and whites do not receive equal care," said Dr. Ashish Jha of the Harvard School of Public Health. He led one of the studies. "We had hoped that all the attention paid to this topic would result in some improvement. What we found is that we have not made much progress."

The Harvard Medical School study of 1.5 million Medicare patients in nearly 200 different managed-care plans provided the most optimism, showing that since Congress in 1997 required managed-care plans to start tracking quality, care has improved overall for both blacks and whites. Blacks were as likely as whites, for example, to receive aspirin and certain drugs for heart disease, blood-sugar tests and eye exams for diabetics. But "the more invasive the procedure was," said a doctor who led a separate Emory University study, "the more difference we found." In fact, the gap widened for diabetic blacks who were unable to control their blood sugar and heart patients who were unable to lower their cholesterol. Black heart patients were less likely to get basic diagnostic tests, drugs or artery-opening procedures, such as angioplasties.

The three most recent studies are reminiscent of a 2002 report by the Institute of Medicine, which found widespread racial disparities in treating heart disease, prostate cancer, emergencies and HIV/AIDS, even when blacks' income and insurance were the same as whites. The reasons have not been studied as much as the reality has been documented, but the racial gaps have been blamed on economic and cultural differences, particularly on blacks having less access to insurance, hospitals and specialists. There also remains a level of distrust that is fueled by such decisions as the Bush administration's scrubbing of a study last year that confirmed "pervasive" racial disparities in health care.

Blacks are diagnosed less and die more. Unfortunately, that is no longer opinion. It's fact.