Gender and geography increase racial disparities in health care, Dartmouth study shows

LEBANON, NH -- Past studies have shown racial disparities in health care treatment around the U.S., but new Dartmouth research published in the October 2nd edition of the New England Journal of Medicine shows that the disparities are even larger when geography and gender are added to the equation.

Looking at the most commonly performed joint replacement surgery - total knee replacements - researchers from Dartmouth Medical School and Dartmouth-Hitchcock Medical Center found widely varying rates of surgery among blacks, whites, and Hispanics.

Surprisingly though, they found that gender and geographic location seem to have a major impact on rates, even within the same racial or ethnic group. For example, in Columbia, S.C., New York City, and Los Angeles, rates of knee replacement were equal or even somewhat higher among African-American women. But among black men in the same cities, rates of knee replacement were about half the rates of white men, or even less. Indeed, in Memphis, rates for black men were less than one-third the rate for white men, and were even very low among black women relative to white women.

"We know that knee replacements are a more common operation for women than for men," says James Weinstein, D.O., M.S., one of the authors of the article. "But even adjusting for that, the differences in the rates for black men and black women in the same cities are dramatic. Where a black woman in Los Angeles is just as likely to have this operation as a white woman, a black man's likelihood of having the procedure is half that of his white counterpart in the same city."

Looking at Medicare statistics from 1998-2000, Weinstein and fellow authors Jonathan Skinner, Ph.D., Scott Sporer, M.D., and John Wennberg, M.D., M.P.H were able to analyze data from 430,726 knee arthroplasties according to region, sex, race, and ethnic group.

"This is the most common joint replacement procedure done in this country," Weinstein sai

Contact: Deborah Kimbell
Dartmouth Medical School

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