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Progress Still Needed on 'Race Gap' in Older Americans' Health
Blacks have made some gains, especially in the West, but whites still fare better overall, study finds
By Amy Norton
WEDNESDAY, Dec. 10, 2014 (HealthDay News) -- Older blacks are still faring worse than whites in the United States when it comes to managing heart disease and diabetes, a new study finds.
Researchers found that from 2006 to 2011, black Medicare patients were consistently less likely than whites to have their high blood pressure, cholesterol and blood sugar under control.
But the study, published in Thursday's New England Journal of Medicine, also turned up some good news: By 2011, the racial divide in health care seemed to have disappeared in the western area of the United States.
"The disparity between African-American and white patients was eliminated. This offers hope that things can improve nationwide," said lead researcher Dr. John Ayanian, director of the Institute for Healthcare Policy and Innovation at the University of Michigan in Ann Arbor.
And what is the West doing right? It's not certain, Ayanian said, but his team found some clues.
It turned out that black seniors in Kaiser Permanente health plans -- a large, California-based insurer -- were doing especially well. And during the study period, Kaiser launched programs designed to help older adults better control conditions like high blood pressure and diabetes, Ayanian said.
Some of the steps, Ayanian noted, included changes to the list of blood pressure drugs offered as a standard benefit to members; greater use of electronic health records, and more email communication between doctors and patients.
In the West, the study found, 74 percent of both black and white patients had their blood pressure under control by 2011. Similarly, about 70 percent in each group had their LDL cholesterol (the "bad" kind) down to healthy levels, while close to 90 percent had reined in their blood sugar.
Ayanian pointed to another bright spot in the findings: Nationwide, Hispanic Americans were doing almost as well as white patients by 2011. Asian Americans, meanwhile, were actually faring better than whites.
A second study in the same journal issue found another positive trend. In U.S. hospitals, racial disparities in access to recommended treatments narrowed or disappeared between 2005 and 2010. For example, many more minorities were getting angioplasty within 90 minutes of arriving at the hospital with heart attack symptoms.
Still, there's more work to be done in narrowing racial disparities in Americans' health, according to Dr. Marshall Chin, who wrote an editorial published with the studies.
"There clearly are some success stories," said Chin, associate chief of general internal medicine at the University of Chicago. "We now know a fair amount about what works to help reduce disparities. But we need the will to widely implement those things."
And that goes beyond changes in hospital procedures or health plan benefits, according to Chin.
He said that health systems, and even individual doctors, should start studying their records to see if there are disparities in how patients of different races fare.
"Change won't happen if [providers] think their care is optimal," Chin said.
Lower-income minorities also need extra help in finding places to buy healthy food and safe places to exercise, Chin noted.
There are health care workers -- like patient "navigators" and community health workers -- who can help disadvantaged seniors find the services they need, Chin said.
"But," he added, "they're underused, and it can be hard to get them reimbursed."
That points to a bigger-picture problem, according to Chin. "The way that our health care system is set up is that it rewards procedures, but it does not reward prevention," he said.
Ayanian agreed that it's more than a matter of health plans making some changes. "People need to be able to buy healthy food, and have places to exercise, and be able to afford copays on their prescriptions," he said.
But seniors' choice of Medicare health plans does matter. Ayanian's team found that half of the disparity between black and white patients was explained by the fact that blacks were more likely to be enrolled in "lower-performing" plans.
Those were plans where all patients were below-average in controlling their blood pressure, cholesterol and diabetes.
Ayanian suggested that people enrolling in Medicare go to the program's website to compare individual plans' quality ratings.
The U.S. health department has more on erasing health disparities.
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