Need to correct racial disparities in health

Dec 8 2004

The number of lives saved by medical advances over the last 10 years is far outdistanced by the number of lives lost to racial disparities in health status, according to a Virginia Commonwealth University family medicine and public health physician.

An analysis of mortality data from 1991 through 2000 shows that technological advances in medicine saved 176,333 lives, while equalizing the mortality rates of whites and African Americans could have saved 886,202 lives, Steven H. Woolf, M.D., professor and director of research in VCU’s Department of Family Medicine, wrote in an article published in the December issue of the American Journal of Public Health.

“Policymakers should reconsider the prudence of investing billions of dollars in the development of new drugs and technologies, while investing only a fraction of that amount in the correction of racial disparities in health,” wrote Woolf, a member of the National Academy of Sciences’ Institute of Medicine.

"Improvements in the technology of care did save lives during 1991 to 2000, but the deaths averted were considerably fewer than the potential lives saved by reducing the mortality rate of African Americans to the rate of whites,” wrote Woolf. “Five deaths could have been averted for every life saved by medical advances.”

Woolf and his colleagues used National Center for Health Statistics mortality data for 1991 through 2000 as the basis for the analysis.

The team calculated the benefit of medical advances from declines in age-adjusted mortality rates, which showed some year-to-year increases, but declined an average of 0.7 percent per year. The group acknowledged that the declines could also be the result of other factors, but gave full credit to medical advances to define the maximum number of averted deaths that could be attributed to the development of better treatments. By their calculations, these declines averted 176,633 deaths in the time period studied.

To determine the number of deaths among African Americans that could be attributed to higher mortality rates, the group performed an indirect standardization of mortality rates and used African Americans as the reference population. During the same time period, age-adjusted mortality rates for white males and females were an average of 29 percent and 24 percent lower, respectively, than those for African Americans. The mortality rate for African American infants and adults aged 25 to 54 was more than double that of whites. Had the age-specific mortality rates of the two races been comparable during the period, the group’s calculations suggested that 886,202 deaths could have been averted, Woolf wrote.

“Much of the billions of dollars spent in the United States to improve health outcomes is directed at the technology of care – the race among private industries and academia to develop better drugs, devices and procedures,” Woolf wrote. “Far less money and infrastructure is devoted to improving health by enhancing equity – achieving equal care for equal need –- and eliminating disparities in the treatment and outcomes of those with similar conditions.”

The methodology and calculations that Woolf and his research team compiled are viewable at www.vcu.edu/fp/research/AJPHaddendum.pdf.