Study Links Poorer Hospital Care to Racial Segregation

For years, doctors and researchers have found that African-Americans with heart disease tend to receive lower-quality care, part of a larger problem of health disparities in America.

Racial segregation may account for some of those differences, according to an article published on the Health Affairs Web site yesterday by researchers at the University of Iowa and the Iowa City Veterans Affairs Medical Center.

In communities where blacks and whites lived more separately from one another or tended to seek care at separate hospitals, African-American Medicare patients suffering from heart attacks were more likely than white Medicare patients to be admitted to hospitals with higher-than-average mortality rates for heart attacks. That was true even among patients who lived closest to a hospital with a better survival rate — a surprising finding because heart attack patients are often advised to rush to the nearest hospital.

The researchers included more than 100 health care markets in their study and used statistics to control for numerous factors that could have biased the results.


Many hospitals were officially off limits to African-American patients until the late 1960s, and the hospitals where they could seek care tended to be of lower quality. “For some of these elderly Medicare beneficiaries, living in a world where they saw signs saying ‘no blacks allowed,’ that’s not too far away for them,” lead author Dr. Mary Vaughan Sarrazin pointed out in an interview with ProPublica. “It’s quite possible, based on that experience, they’re just not comfortable going to another hospital.”

“We need to look more at these structural factors that are built into our society because of racism,” Dr. Somnath Saha, an associate professor of medicine at who studies racial disparities in health care but wasn’t involved in the current investigation, told ProPublica. “This study shows we can’t ignore those factors anymore.”

Sheri Fink

Dr. Sheri Fink has reported on health, medicine and science in the U.S. and from every continent except Antarctica. Since 2004 she has been a frequent contributor to the public radio newsmagazine PRI’s “The World,” covering the global HIV/AIDS pandemic and international aid in development, conflict and disaster settings. Her articles have appeared in such publications as the New York Times, Discover and Scientific American. Fink’s book War Hospital: A True Story of Surgery and Survival (Public Affairs, 2003) won the American Medical Writer’s Association special book award and was a finalist for the Overseas Press Club and PEN Martha Albrand awards. Fink has taught at Harvard, Tulane and the New School. Most recently she was the recipient of a Kaiser Media Fellowship in Health from the Kaiser Family Foundation.

Republished with permission from Pro Publica.


  1. Terry Nash says

    For a long time I have been upset over the way my white, military retiree husband was treated by the medical dynasty. He had bucko insurance (benefited from military and non-military jobs). The doctors seemed to look at how much insurance he had and prescribe all kinds of tests that were only border-line aspects of his condition. I called his primary physician (who obviously was not following his case,but also benefited from numerous insurance and medicare charges) and said why is my husband subjected to every test conceivable test and surgical procedures that were not vital to his case. My husband was the victum of an incurable disease. We spent precious hours and too much of the public’s money going round and round to different procedures and tests that were acceptable to Medicare and insurance companies because symptomoloty could support the possibilty of even more diseases. In my opinion these were side-effects to the meds (more than thirty) that he was being prescribed.

    I say all of this, to identify the fact that poor (and exploitive) medical care touches all races and economic spheres. My husband died without even seeing the results of many of these very expensive tests.

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