No racial differences in mortality found among Veterans Health Administration out-patients.
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.
Selim
Alfredo J
AJ
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
Fincke
Graeme
G
Berlowitz
Dan R
DR
Cong
Zhongxiao
Z
Miller
Donald R
DR
Ren
Xinhua S
XS
Qian
Shirley
S
Rogers
William
W
Lee
Austin
A
Rosen
A K
AK
Selim
Bernardo J
BJ
Kazis
Lewis E
LE
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