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Steven H. Woolf, MD, MPH, Department of Family Practice, Virginia Commonwealth University, 3712 Charles Stewart Drive, Fairfax, VA 22033, 703-391-2020 ext 141, swoolf@vcu.edu, Robert E. Johnson, PhD, Departments of Family Practice and Biostatistics, Virginia Commonwealth University, P.O. Box 980251, Richmond, VA 23298, George E. Fryer, MSW, PhD, American Academy of Family Physicians Center for Policy Studies in Family Practice and Primary Care, 1350 Connecticut Avenue, N.W., Suite 950, Washington, DC 23284, George Rust, MD, MPH, Director, National Center for Primary Care, Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA 30310, and David Satcher, MD, PhD, Moorehouse School of Medicine, Director, National Center for Primary Care, 720 Westview Dr., SW, Atlanta, GA 30310.
Society invests more of its resources in enhancing the effectiveness of care (developing new drugs, devices, and procedures) than in efforts to correct racial and ethnic disparities. We compared the degree to which society benefits from each endeavor, using whites and African Americans as our comparison groups and avoidable deaths as our metric. For the years 1991-2000, we contrasted the number of lives saved through secular reductions in mortality rates and the number of avertable deaths had African Americans experienced the same mortality rates as whites. We relied on national vital statistics data from a representative sample of the U.S. population, as obtained by the National Center for Health Statistics. We viewed secular reductions in mortality rates as a crude measure of the public health benefits of improving the effectiveness of care. We reasoned that the number of lives saved from this effort is probably less, but can be no greater than this value. We calculated the number of potentially avertable deaths from the correction of racial disparities in mortality by applying methods analogous to those used in standardized mortality ratios. Age-adjusted mortality rates during 1991-2000 declined by an average of 0.7% per year, averting 176,633 deaths over the course of the decade. Age-adjusted mortality rates for white males and females were, respectively, an average of 29% and 24% lower than those of African American males and females. Had the age-specific mortality rates of the two races been comparable, 886,202 deaths could potentially have been averted. The ratio between this number and the number of deaths potentially averted by generic improvements in care is 5.0. Although generic improvements in the effectiveness of health care did save lives during 1991-2000, the maximum number of averted deaths attributable to this endeavor was considerably less than the number of lives that could have been saved during those same years if the mortality rates of whites and African Americans had been equalized. Five African American deaths could have been averted for every life saved by generic improvements in care. Although national efforts are underway to address racial and ethnic disparities in health, the investment is a fraction of society's expenditure on developing new drugs and other measures to make health care more effective. More lives could be saved if national priorities focused less on this objective and more on achieving equity.
Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to
Keywords: Social Inequalities, Mortality
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.