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Ashish K. Jha, MD; Michael G. Shlipak, MD,MPH; Wylie Hosmer, BS; Craig D. Frances, MD; Warren S. Browner, MD,MPH

JAMA. 2001;285:297-303.

Context  Racial disparities in health care delivery and outcomes may be due to differences in health care access and, therefore, may be mitigated in an equal-access health care system. Few studies have examined racial differences in health outcomes in such a system.

Objective  To study racial differences in mortality among patients admitted to hospitals in the Veterans Affairs (VA) system, a health care system that potentially offers equal access to care.

Design, Setting, and Participants  Cohort study of 28 934 white and 7575 black men admitted to 147 VA hospitals for 1 of 6 common medical diagnoses (pneumonia, angina, congestive heart failure, chronic obstructive pulmonary disease, diabetes, and chronic renal failure) between October 1, 1995, and September 30, 1996.

Main Outcome Measures  The primary outcome measure was 30-day mortality among black compared with white patients. Secondary outcome measures were in-hospital mortality and 6-month mortality.

Results  Overall mortality at 30 days was 4.5% in black patients and 5.8% in white patients (relative risk [RR], 0.77; 95% confidence interval [CI], 0.69-0.87; P = .001). Mortality was lower among blacks for each of the 6 medical diagnoses. Multivariate adjustment for patient and hospital characteristics had a small effect (RR, 0.75; 95% CI, 0.66-0.85; P<.001). Black patients also had lower adjusted in-hospital and 6-month mortality. These findings were consistent among all subgroups evaluated.

Conclusions  Black patients admitted to VA hospitals with common medical diagnoses have lower mortality rates than white patients. The survival advantage of black patients is not readily explained; however, the absence of a survival disadvantage for blacks may reflect the benefits of equal access to health care and the quality of inpatient treatment at VA medical centers.

Author Affiliations: General Internal Medicine Section, Veterans Affairs Medical Center, and Department of Medicine, University of California, San Francisco. Dr Browner is currently at the Research Institute, California Pacific Medical Center, San Francisco.

RELATED LETTER

Health Outcomes for Black and White Patients in the Veterans Affairs Health Care System
John A. Hermos, William F. Page, Ashish K. Jha, Michael G. Shlipak, and Warren S. Browner
JAMA. 2001;285(14):1837-1838.
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