Buckle
JM, Horn SD, Oates VM, Abbey H.
Severity of illness and resource use differences among white and black
hospitalized elderly.
Arch Intern Med 1992;152(8):1596-603.
This study examined differences in illness severity, changes in severity,
and length of stay between elderly black and white hospitalized patients.
The study was conducted at two urban teaching hospitals and the sample was
comprised of 1,184 patients. Severity of illness upon admission, during
the hospitalization (maximum severity) and upon discharge was derived using
the Computerized Severity Index. The results indicated that blacks were
more severely ill than whites upon admission and had significantly shorter
hospitalizations and lower charges for each level of severity (such differences
were unable to be explained by disease, surgery, age, hospital, and payer).
The findings raised questions about the social and cultural practices
of patients seeking health care. The authors questioned (1) whether admissions
to hospitals for blacks were delayed; (2) why fewer resources were used
for blacks than for whites at the maximum severity level; and (3) whether
providers systemically discriminate in their choice of prescribing of
treatments for black and white patients.
The authors were unable to answer the latter two questions for the following
reasons: data on the characteristics of provider and on the use of ancillary
services were unavailable; no data existed on the social support systems
of patients or the role of the patient or informal care giver in the health
care decision-making process; and it was not possible to control for use
of resources at the individual disease level. Another limitation of the
study was the lack of a good measure of socioeconomic status.
The authors conclude that the results of this study support the findings
that differences in access to care and resource use exist between black
and white patients and that “policy interventions and further research
should be aimed at understanding and decreasing these differences.”
They suggest that such disparities may exist due to decisions by patients
to seek care or provider admitting practices and may represent either
underutilization for blacks or overutilization in whites.
