Researchers in John Wennberg’s shop at Dartmouth have come out with another stunning analysis of practice variation published in the new England Journal of Medicine (NEJM). This time it’s not region that makes a difference, but race of the patient. Essentially the article says that you are much less likely to receive a common type of knee surgery if you are black or hispanic than if you are white.
We’ve know for a long time that outcomes and health status are impacted by race and socio-economic status (SES). For instance black males in Harlem have much lower life expectancy than average. Similarly, despite the 50 years of Universal Health Insurance and care from the National Health Service in the UK, SES or "class" level there has a marked impact on health status and outcomes. In fact variation in employment status within the same SES, also has a large impact (and not surprisingly it’s better to be at the top than the bottom), as shown in the classic British Whitehall Study. And of course we also know that access to care for those without insurance is worse in the US than for those with insurance.
However, I believe that this is the first example in the US showing that access to a specific type of care for those in the same insurance category is very different. I don’t know why black seniors in the US have knee surgery at half the rate of white seniors. I suspect both patient demand, and physician culture have something to do with it. I also don’t know which rate of knee surgery is better.–especially as last year the NEJM published a study that said that in the case of osteoarthritis, knee arthoscopy was no better than placebo. But it is clear that race and presumably other social factors influence the treatment that is given to patients with similar conditions for no good reason.
(Alerted to this by California Healthline)