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Racial Disparities Persist in Heart Care

Studies point up gaps in many areas of cardiac treatment

TUESDAY, March 15, 2005 (HealthDay News) -- Racial disparities continue to taint heart care in the United States.

That's the message of the special, themed March 15 issue of Circulation, which includes 17 original studies on the subject. Findings from some of the research were presented Tuesday at a news conference in New York City.

"In the face of advances in medicine, it is particularly striking that disparities in cardiovascular disease based on ethnicity and race persist," said Dr. Emilia Benjamin, an editor at Circulation.

The authors of one study found that blacks who suffer the most common type of heart attack are less likely than whites to get expensive or new treatments.

The study, which looked at 37,813 white and 5,504 black high-risk heart patients at 400 hospitals nationwide, found black patients were more likely to be young, female, and have risk factors such as high blood pressure, diabetes and a history of smoking. Black patients in general were more likely to be uninsured or underinsured, and less likely to be treated by a cardiologist while hospitalized.

While death rates among the two groups were about the same, high-risk blacks were less likely to receive newer drugs but as likely or more likely than whites to receive older therapies such as aspirin, beta blockers, ACE inhibitors and heparin, a blood thinner. Black were also less likely to have catheterization, bypass surgery or angioplasty.

"Patients who were most likely to benefit were the ones who were least likely to be treated," said study author Dr. Ali F. Sonel, director of cardiac catheterization laboratories at Veterans Affairs Pittsburgh Healthcare System. "It's somewhat reassuring that black patients receive some medications as often as whites, but troubling that new agents are underutilized in black patients."

The study also found that certain low-cost interventions such as counseling to quit smoking were less likely to be used with black patients. This was "surprising," Sonel said.

Those findings really backed up another study, conducted by the U.S. Centers for Disease Control and Prevention, which examined national surveys and found health-care disparities are pervasive and adversely affect the cardiovascular health of Americans, especially those who belong to racial or ethnic minorities and who are poor or uneducated.

"Disparities in heart disease and stroke and related risk factors remain very pervasive," said study author Dr. George Mensah, acting director of the National Center for Chronic Disease Prevention. Overall, life expectancy in women exceeded that in men by about five-and-a-half years and, in whites, exceeded that of blacks by about the same. There were also more premature deaths among women than men, and among blacks than whites. Black men and women had higher death rates in all age groups. Black women had the highest prevalence of obesity.

Another study suggested that physician attitudes may play a part in the disparities.

A survey of 344 cardiologists found that only one-third of the respondents believed that racial and ethnic disparities in care occur in this country. This was the finding, despite hundreds of papers in the medical literature indicating that such disparities exist, said study author Dr. Nicole Lurie, the Paul O'Neill Alcoa professor of health policy at Rand Corp. Most of the respondents were male and white, she added.

"There was a big disconnect between people who thought this was a problem for the nation [34 percent], and only 12 percent who thought the disparities existed in their own hospital and fewer than 5 percent who agreed that this problem might exist in their own practice setting," she said.

Also, physicians seemed to be inclined to pass blame for the problem. "Cardiologists were pretty quick to identify system factors such as lack of health insurance or lack of time, and to identify factors about the patients themselves, for example, not adhering to treatment. But far fewer cited physician factors, such as miscommunication," Lurie said.

Black physicians, on the other hand, were five times more likely than white doctors to agree that disparities exist, while women physicians were more than twice as likely as male doctors to acknowledge the gaps.

Other studies found more discrepancies. U.S. women, especially those from racial and ethnic minorities, were ill-informed about the warning signs of stroke, said a survey conducted in 2003. Although the scores were higher than similar results found in 1997 and 2000, they still showed a "low level of awareness about stroke," said study author Dr. Anjanette Ferris, a clinical fellow in cardiovascular disease at Columbia University Medical Center in New York City.

In New York state, "report cards" intended to improve the quality of coronary artery bypass graft (CABG) surgery by giving physicians report cards may actually have backfired, another study found. After the state started issuing its CABG report cards, 19 percent fewer blacks and Hispanics received this type of surgery than whites.

"Black and Hispanic patients were less likely to receive CABG after the report cards were released," stated study author Dr. Rachel M. Werner, an assistant professor of medicine at the University of Pennsylvania in Philadelphia. The gap, however, subsided over time -- after nine years, the racial disparities returned to where they were.

A final paper in the journal called for more research, advocacy and education to reduce disparities. Among other things, minorities need to be recruited into studies both as participants and as researchers. "Minorities are not hard to reach," said Benjamin, quoting a colleague of hers. "They are hardly reached."

More information

Visit the U.S. Department of Health and Human Services for more on closing the heart disparity gap.

SOURCES: March 15, 2005, press conference with George Mensah, M.D., acting director, National Center for Chronic Disease Prevention and Health Promotion, and chief, Cardiovascular Health Branch, U.S. Centers for Disease Control and Prevention, Atlanta; Nicole Lurie, M.D., Paul O'Neill Alcoa professor of health policy, Rand Corp., Arlington, Va.; Anjanette Ferris, M.D., clinical fellow, cardiovascular disease, Columbia University Medical Center, New York City; Rachel M. Werner, M.D., assistant professor, medicine, University of Pennsylvania, Philadelphia; Ali F. Sonel, M.D., director, cardiac catheterization laboratories, Veterans Affairs Pittsburgh Healthcare System, and assistant professor, cardiology, University of Pittsburgh; Emilia Benjamin, editor, Circulation; March 15, 2005, Circulation
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