MONDAY, Feb. 10, 2003 (HealthDayNews) -- It's no secret that blacks in America often receive worse health care than whites. However, while a string of studies have confirmed the problem, finding the culprit hasn't been easy.
Now, new research suggests that some of the usual suspects -- including poverty -- may not be entirely to blame.
Blacks with diabetes are less likely to get proper medical care -- including such things as flu shots -- than white diabetics, even after taking income level and access to doctors into account, says a new study.
"We're not sure what exactly this means, but what it does tell us is that these factors are not responsible for the differences," says study co-author Leonard E. Egede, an assistant professor of medicine at the Medical University of South Carolina.
The study results leave open the possibility of other causes for the lesser care, such as how blacks and whites view medical treatment and what they expect from their doctors, Egede says.
However, he's skeptical that racism plays a major role.
Egede and a colleague examined national survey statistics from 1998 and selected 1,906 diabetics. The researchers then determined how many received flu shots and were vaccinated against a common group of diseases known as pneumococcal infections, including some of the most deadly strains of pneumonia.
Only 39 percent of blacks reported getting flu shots, compared to 55 percent of whites. The numbers were 22 percent and 38 percent, respectively, for pneumococcal vaccinations.
Significant differences between the races remained even when the researchers adjusted the figures for access to health care, insurance coverage and socioeconomic status.
Federal guidelines suggest the vaccinations should be routine, especially for people aged 65 and older. Flu shots must be given once a year, while people only need to be vaccinated once against pneumococcal infections.
"Immune response and the ability to fight infection is lowered with people with diabetes," Egede explains. "There's a lot of evidence that they do tend to have high mortality rates during flu epidemics."
The findings of the study appear in the February issue of the American Journal of Public Health.
Egede is cautious about speculating why whites get more vaccinations than blacks. "White patients may be more likely to seek care and blacks may have more distrust [of doctors]," he says. "That's one possibility, but we don't have the data to support that."
In searching for an explanation, Egede says he prefers to look at how whites and blacks communicate with each other: "People may not know how to deal with people from other races, and they may find it difficult to convince them to take a flu shot."
The role of race in the doctor's office is difficult to study, says Dr. Giselle Corbie-Smith, an assistant professor of social medicine and internal medicine at the University of North Carolina. Egede's study is a "really nice first step" because it peels away the layers to get to the root causes of differences in treatment, she says.
"There's nothing biologically different between a black person with diabetes and a white person that would make one get the vaccine and the other not," she says. "There is something about their skin color, maybe their interactions with other people or the health system, that makes it less likely they'll be offered or accept a vaccination."
More information
To learn more about health issues affecting minority groups, visit the U.S. Department of Health and Human Services or the Minority Health Center.
