Short-term and Long-term Racial Disparities in VA and non-VA Hospital Outcomes

This research used VA and Medicare data to examine racial patterns in short- and long-term mortality outcomes for elderly male black and white patients hospitalized for heart attack, stroke, hip fracture, congestive heart failure, gastrointestinal bleeding, and pneumonia from 1998 to 2002. The researchers found that at 30 days after admission for five of the six conditions, racial patterns in mortality outcomes were similar in VA and non-VA settings, with black patients having a survival advantage. Among Medicare patients, relative to the mortality outcomes for whites, mortality outcomes for black patients deteriorated over time until black Medicare patients had worse 2-year mortality for all conditions except congestive heart failure. In contrast, among VA patients, the relative decline in mortality for blacks was less marked and statistically significant only for hip fracture and stroke. These findings suggest that factors unrelated to hospital care play important roles in longer term mortality rates for the examined conditions. The findings also suggest that the integrated health care delivery system of the VA may attenuate racial disparities in health by mitigating the environmental factors that contribute to mortality for up to two years after hospitalization.