"VA health care is 'color-blind,'" said one of the study authors, Victor F. Froelicher, MD, a cardiologist at the VA Palo Alto Health Care System.
The study compared the long-term survival of white, Hispanic and African-American veterans referred for electrocardiograms (EKGs) or exercise tests at the Palo Alto and Long Beach VA sites from 1987 to 2000. Researchers used the results of these tests, along with age and other clinical data, to control for health factors that may have influenced survival and thereby isolate the effects of race alone.
Before adjusting for clinical and age differences, the researchers found that the death rates among whites were higher than for blacks or Hispanics-possibly because white patients tended to be older. Among those referred for exercise testing, 3.4 percent of whites died over the 12 years, compared to 2.9 percent of blacks and 2.2 percent of Hispanics.
After adjustments for age and cardiac health status, Hispanics still showed a survival advantage. They were only about 80 percent as likely as whites or blacks to die over the course of the study. There was no difference between black and white survival rates. In explaining the apparent survival advantage of Hispanic VA patients over the other two groups, Froelicher cited their strong social support as a possible factor.
Medical research on the impact of race on mortality has produced mixed results. Generally, blacks are reported to have poorer cardiovascular outcomes, possibly because of reduced access to quality health care.
On the other hand, a 2001 study by Dr. Ashish Jha and colleagues at the San Francisco VA Medical Center found that African-Americans admitted to VA hospitals with any of six common diagnoses-including two heart conditions-had lower mortality rates than whites. Research on Hispanics, too, has been inconclusive, with some studies indicating higher cardiovascular mortality than whites and other studies showing the opposite.
According to Froelicher and colleagues, their study is the first of its kind to consider baseline EKG and exercise test scores, along with an array of other indicators of cardiovascular health, in comparing mortality among racial groups.
"No prior study has had such data available, and it is important to adjust for these findings because cardiovascular diseases are the major cause of death in the veteran population," the researchers wrote in their report.
Froelicher noted that the study, in contrast to most research on health care disparities, assessed quality of care based on how long patients lived, not what procedures they received. Several studies have shown that blacks generally receive fewer cardiac procedures than whites-such as revascularization-although the reasons for the discrepancy are unclear. It is also uncertain whether an increased rate of medical procedures translates into better health outcomes.
"Why should any group have the adequacy of their care assessed by number of procedures?" said Froelicher. "Perhaps some patients show better sense by refusing certain procedures. More procedures and more expensive health care may not be better for your health."
Froelichers's collaborators on the study included lead author Manish Prakash, MD, Sara Partington, Paul Heidenreich, MD, and Jonathan Myers, PhD, all of the Palo Alto VA Health Care System and Stanford University.
The VA and Stanford University supported this study.
Journal
Archives of Internal Medicine