Black senior citizens who need surgery for the intestinal disorder diverticulitis are significantly more likely to die in the hospital than their equally ill white counterparts, even when each racial group carries the same health insurance, new Johns Hopkins research suggests

While all of the patients in the study required surgery, black patients were 26% more likely than white patients to undergo riskier and more expensive emergency diverticulitis surgery rather than elective scheduled surgery for their condition, the Hopkins researchers found. Black seniors also spent more time in the hospital recovering from their operations and the costs of their stays averaged nearly $30,000 more than those of comparable white patients. The researchers say that while lack of insurance is often a major driver of racial disparities in health care, their analysis shows that even with equal access to a doctor, race-based differences in outcomes persist. "Even if everyone has coverage, black patients are doing worse, so we need to find out what else is going on," says study leader Eric B. Schneider, Ph.D., an epidemiologist at the Johns Hopkins Center for Surgical Trials and Outcomes Research. "Maybe then we can make a difference." Schneider and his team analyzed data from more than 50,000 Medicare patients who underwent surgery removal of part of the colon with or without or a colostomy procedure between 2004 and 2007 in the United States. The researchers, adjusting for age, gender and other underlying illnesses, found that being black was associated with a 28% increase in in-hospital mortality, regardless of whether the patient underwent emergency or pre-planned surgery. Previous research has found higher rates of mortality, complication and readmission among black surgical patients when compared to white patients undergoing similar procedures. Schneider says the conventional wisdom is that black patients' poorer outcomes can largely be accounted for by differences in socioeconomic status, including health insurance coverage and greater underlying comorbidity. The new research contradicts that hypothesis, he says. Schneider says that past research has shown that even when they have insurance, black patients are less likely to go to the doctor than white patients, even for routine preventive services such as vaccination. Black patients may also have more undetected or undiagnosed illnesses than white patients, as research shows black patients are less likely to undergo diagnostic evaluations than white patients.