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A major study examining differences in the healthcare that black and white seniors receive was published in the August 18, 2005 issue of the New England Journal of Medicine. The study, funded by the Robert Wood Johnson Foundation (RWJF) and conducted by a research team led by Ashish Jha, MD, MPH, and Arnold Epstein, MD, MA, of the Harvard School of Public Health, and Elliott Fisher, MD, MPH, of Dartmouth Medical School, found that from 1992 to 2001, blacks received significantly fewer surgeries that help seniors live better and longer lives compared to whites.


The study also found that in many cases, these differences in care are getting worse. "For more than 20 years we have known that black Americans receive a different level of care than whites," said Jha, Assistant Professor of Health Policy and Management at the Harvard School of Public Health. "Despite concerted efforts to address these disparities, this study shows that black seniors continue to receive fewer surgical procedures than whites. On a fundamental level, these differences in care are not acceptable."


The first study to look at the use of major, potentially life-saving surgeries among black and white seniors, this research examined how often nine types of surgical procedures, ranging from heart bypass surgery to total hip replacement, were performed on Medicare enrollees from 1992 to 2001. The analysis shows that in 1992, white patients had higher rates for each of the nine types of procedures. By 2001, the gap had not substantially decreased in eight of the procedures, and in five it had instead increased sharply: back surgeries, valve replacements, hip replacements, knee replacements, and appendectomies.


"We hope that [studies like this one] will succeed in engaging others to join us in the effort to find solutions to racial and ethnic gaps in treatment. Solutions will need to involve all those who have an impact on the quality of healthcare, such as federal and state governments, patients and consumers, physicians, hospitals, and health plans," said Risa Lavizzo-Mourey, MD, MBA, President and CEO of the Robert Wood Johnson Foundation.


The study is also significant because of the scope of the data analyzed. By using Medicare enrollees as the sample population, the study examined care for nearly 40 million Americans.


"Looking at these trends over time helps everyone to understand the level of effort that will be needed to address the problem of racial and ethnic disparities in care," said Fisher, Professor of Medicine and of Community and Family Medicine at Dartmouth Medical School. "It's important to monitor the problem-it's equally important to start focusing on solutions."


To view the full report, "Trends in the use of major procedures among the elderly: Are racial differences narrowing?" visit the New England Journal of Medicine Web site at or


Data for the study were provided by the Dartmouth Atlas Project,


Data for selected regions of the country can be obtained at