Study shows unusual racial health care ‘paradox’

On most health measures, blacks fare much worse than whites — differences that have largely been attributed to socioeconomic factors, access to health care and discrimination by doctors in the treatments they prescribe.

But if there were a health system in which all patients basically got the same care, would the disparities still exist?

It turns out there is such a system: the U.S. Department of Veterans Affairs. And a new analysis of nearly 3.1 million patients in the VA system has found a different kind of racial divide: Blacks do significantly better than whites.

Over a nine-year period, researchers found that the adjusted mortality rate of African Americans was 24 percent lower than that of whites, according to a study published this month in the journal Circulation.

“We thought we were going to show they do the same if the same care is offered to both groups,” said senior author Dr. Kamyar Kalantar-Zadeh, a nephrologist and epidemiologist at UC Irvine. “But we found blacks do even better.

“This is a paradox within a paradox,” he said.

In an editorial that accompanied the study in Circulation, Drs. Nakela Cook and George Mensah of the National Institutes of Health said the results raise important questions about health disparities in the U.S. They also cautioned that though there may be biological differences between blacks and whites, other factors could be at work as well.

For instance, they wrote, blacks in the VA system might have better underlying health than blacks in the general population — a gap that may be less pronounced for whites. Exercise, diet and other factors not considered in the study could also play a role.

And though the VA offers open-access health care to all veterans who qualify, there may be racial differences in how treatment is provided.