title: No racial differences in mortality found among Veterans Health Administration out-patients.
abstract: OBJECTIVE
  Health care delivery systems that offer equal access to ambulatory care may hold promise for preventing and correcting racial disparities that exist in our health care system as a whole. We examined whether racial differences in mortality rates exist among patients receiving outpatient care within the Veterans Health Administration.
  
  
  METHODS
  This study used data from the 1998 National Survey of Ambulatory Care Patients, a prospective monitoring system of patient outcomes. We used an outpatient care system in the Veterans Health Administration. We followed 25,172 Whites and 3,517 African-Americans for 48 months. The main study outcome measures were unadjusted and adjusted mortality rates over a 48-month period.
  
  
  RESULTS
  African-Americans had significantly lower unadjusted 48-month mortality rates than Whites (33 vs. 40 deaths per 1,000 person-year, hazard ratio, 0.84; 95% confidence interval [CI], 0.75-0.95). After risk adjustment, the mortality rates became similar for African-Americans and Whites (hazard ratio, 0.99; 95% CI, 0.89-1.09). These findings were consistent across all time points evaluated during the 48-month follow-up.
  
  
  CONCLUSIONS
  The lack of racial differences in mortality in patients receiving ambulatory care in the Veterans Health Administration is reassuring, given the emphasis on equal access within this health care system. This warrants further research to determine whether efforts to improve access in other settings have the potential to reduce racial disparities in health care.
authors.affiliation: Center for Health Quality Outcomes and Economic Research, VA Medical Center, Bedford, and Boston University School of Medicine and Public Health, MA, USA. Selim.Alfredo_J@Boston.Med.VA.gov
authors.forename: Alfredo J
authors.initials: AJ
authors.lastname: Selim
authors.forename: Graeme
authors.initials: G
authors.lastname: Fincke
authors.forename: Dan R
authors.initials: DR
authors.lastname: Berlowitz
authors.forename: Zhongxiao
authors.initials: Z
authors.lastname: Cong
authors.forename: Donald R
authors.initials: DR
authors.lastname: Miller
authors.forename: Xinhua S
authors.initials: XS
authors.lastname: Ren
authors.forename: Shirley
authors.initials: S
authors.lastname: Qian
authors.forename: William
authors.initials: W
authors.lastname: Rogers
authors.forename: Austin
authors.initials: A
authors.lastname: Lee
authors.forename: A K
authors.initials: AK
authors.lastname: Rosen
authors.forename: Bernardo J
authors.initials: BJ
authors.lastname: Selim
authors.forename: Lewis E
authors.initials: LE
authors.lastname: Kazis
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000592:standards / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011787:Quality of Health Care; D020379:Risk Adjustment; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data