Studies by Bach and others suggest a different explanation: The USA's health care system remains as divided by race as its neighborhoods, schools and other aspects of American life.
"African-Americans live in very different places than whites, and in general they get treated at lousy hospitals," says Amitabh Chandra, an assistant professor at Harvard University and co-author of a new paper about health disparities.
The study, published today in the journal Circulation, suggests that black patients are concentrated in a small number of poorly performing hospitals. Nearly 70% of black heart attack patients went to only about 20% of medical centers, according to the study, which examined more than 1 million Medicare recipients from 1997 to 2001. At hospitals treating the most blacks, death rates for all heart attack patients were 19% higher than at the facilities that saw only white heart attack victims.
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