Lack Of Insurance Might Explain Racial Health Disparities

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Insurance status might explain why blacks have poorer outcomes after being diagnosed with diverticulitis than whites, according to a study published in the December issue of Archives of Surgery, HealthDay/Washington Post reports.

Diverticulitis is a condition that involves the inflammation and infection of small pockets that form in the intestine. Complications can lead to bowel obstruction, hemorrhaging or perforation of the intestine. More than 200,000 U.S. residents are hospitalized for diverticulitis annually, and blacks generally have poorer outcomes related to the condition than whites, according to HealthDay/Post.

For the study, lead author Anne Lidor, an assistant professor of surgery at Johns Hopkins University, examined data on more than 45,500 people treated for diverticulitis between 1999 and 2003. Researchers found that uninsured patients were more likely to fare poorly after diagnoses than those with health insurance. The uninsured also were 164% more likely to die after undergoing surgery than insured patients, David Chang, senior author of the study, said. He noted that black patients are less likely to be insured.

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According to the study, "insurance status did correlate with the type of treatment provided. Uninsured and underinsured patients were more likely to receive a colostomy -- even after adjusting for a higher rate of complicated diverticulitis (seen) in those patients than their insured counterparts."

Chang said, "What this is showing is that insurance is a contributor to the disparity in racial outcomes," adding, "A racial disparity in diverticulitis outcomes has been described for decades," Chang added. Race was not associated with the kind of surgical treatment received by patients, researchers noted.

Selwyn Rogers, an associate professor of surgery at Harvard Medical School and Brigham and Women's Hospital who wrote a commentary accompanying the study, said, "The policy implication" for the finding "is that when you don't see equal care, we should focus on designing interventions to get equal care." He added, "If you have an excellent health insurance plan, you get referred to helpful surgeons and high-quality hospitals. Hopefully, you don't present with the kind of complications that might require" surgery (Edelson, HealthDay/Washington Post, 12/15).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Weekly Health Disparities Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Weekly Health Disparities Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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