Racial differences found in hospital death rates

Minorities were found more likely to die after being hospitalized

A new study of patients in Hawaii and 21 other states found African Americans, Pacific Islanders and Asians have a higher risk than Caucasians of dying in hospitals after suffering injuries.

"There is substantial and growing evidence of pervasive racial disparities in access to appropriate medical care in a variety of contexts and for a wide variety of medical conditions," the researchers said.

The study was co-authored by Dr. Jerris Hedges, the new dean of the John A. Burns School of Medicine at the University of Hawaii at Manoa.

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Asian, Pacific Island and African-American patients have a higher risk than Caucasians of dying in hospitals after suffering injuries, according to a study co-authored by the new dean of the John A. Burns School of Medicine.

Dr. Jerris Hedges, former vice dean of the Oregon Health and Science University School of Medicine, and colleagues in Portland analyzed data from Hawaii and 21 other states in a Healthcare cost and Utilization Project from 1998-2002.

Their report, "Racial Disparities in Mortality Among Adults Hospitalized After Injury " was published in the February issue of Medical Care, a national journal.

The study focused on patients 18 to 64 with injuries mostly to their head, legs, chest, spleen or liver.

African Americans and Asians, including Pacific Islanders, had a higher risk of death in hospitals -- 2.1 percent and 2 percent respectively -- than Caucasians at 1.5 percent, the study found. Other ethnic groups were about the same as Caucasian patients.

Researchers found evidence that physicians might "unconsciously incorporate negative racial stereotypes into their assessment of patients, and this likely affects treatment decisions."

Hedges, an emergency medical specialist, said in an e-mail, "The issue of health disparities is not unique to Hawaii but should concern all residents of Hawaii ... The poorer survival outcome for Asian and Pacific Island patients is concerning."

The study examined 489,025 hospitalizations, of which 67 percent were non-Hispanic white patients; 15 percent African American, 12 percent Hispanic and 2 percent Asian. (No breakdown was given for Pacific Islanders.)

Caucasian patients were more likely than other racial and ethnic groups to be privately insured and, with Asian patients, were least likely "to live in a zip code with median income of less than $25,000," the report said.

It said racial disparities among black patients were largest among mild to moderately injured patients where there was likely to be more discretion in making decisions.

Among Asian patients, language barriers may have interfered with appropriate treatment for many, resulting in disparities, the report said.

Injury is the "third leading contributor to racial disparities in mortality" but little scrutiny has been given to differences in health care for injured patients after hospital admission, the study said.

Hedges said Hawaii's cultural diversity provides "a fertile ground" for studies looking at health access and outcome disparities. He said he hopes efforts can be strengthened "to save the lives of those with major injury through a systems approach to trauma care delivery."

The UH medical school established a Center for Native and Pacific Health Disparities Research in December within the Department of Native Health.

Dr. Marjorie Mau, the center's co-director, said in announcing the development that future studies are important to understand why there are racial/ethnic differences in health outcomes after an injury.

Dr. Danny Takanishi, Department of Surgery chairman, said his department and the Department of Native Hawaiian Health will collaborate with other community groups to investigate epidemiology of traumatic injuries.