Separate but not equal: the consequences of segregated health care.

Abstract

Cardiovascular disease accounts for as much as one third of the differential in life expectancy between blacks and whites in the United States.1 A multifactorial process likely leads to these disparate outcomes (see the Figure), including differences in biology, differential awareness, knowledge, beliefs, and preferences for care for cardiovascular disease, and varying distribution of risk factors (including hypertension, obesity, and life stresses that include poverty and discrimination). Furthermore, blacks in the United States have a greater burden of cardiovascular disease2 and face greater challenges accessing health care, with lower rates of health insurance coverage, less access to a regular primary care doctor, and more frequent use of emergency departments for care.3 Then, once they have accessed the healthcare system, blacks often receive a poorer quality of care than do whites.4–6 Thus, it is no surprise that black patients’ outcomes, whether measured by functional status or mortality, are worse,7,8 and the study in this issue of Circulation by Skinner and colleagues9 adds further weight to this body of evidence. Model of possible pathways toward racial disparities in cardiovascular outcomes. Article p 2634 The results from Skinner et al9 support the notion that segregated health care is not equal and that it has a negative impact on the life expectancy of all patients receiving care in facilities with high proportions of black patients. Their results indicate that patients (both white and black) hospitalized for acute myocardial infarction (AMI) between 1997 and 2001 at …