Decades of work to reduce disparities in health care produce limited success.

THE EARLY WEEKS OF 2008 BROUGHT discouraging news for advocates working to narrow health care disparities among racial and ethnic groups. In rapid succession, several studies published in January in peer-reviewed journals showed that despite decades of efforts to raise awareness about disparities and to reduce them, the gaps in some key treatment areas have not budged. The latest findings build on years of research that has established the extent of inequalities in treatment for cancer, heart disease, diabetes, and many other conditions. Cancer, for example, has been the focus of dozens of studies and a number of federal initiatives to document and reduce treatment disparities. However, a new analysis of 143 512 Medicare patients with breast, colorectal, lung, and prostate cancers shows that from 1992 to 2002, not only did treatment disparities persist, the magnitude of the disparities did not diminish (Gross CP et al. Cancer. 2008;112[4]:900-908). A number of studies also have documented racial and ethnic disparities in pain control, and several initiatives have sought to improve the overall quality of pain management. But even though prescriptions for pain-relieving opioid drugs rose by 60% in emergency departments from 1993 to 2005 following campaigns to improve pain control, minority patients did not receive these drugs as often as white patients. In 2005, opioid prescriptions were 8% higher in white patients in the emergency department than in minority patients (Pletcher MJ et al. JAMA. 2008; 299[1]:70-78). Withgreaterawarenessdirectedtoward the issue through such majorreports as theInstituteofMedicine’sUnequalTreatment: Confronting Racial and Ethnic Disparities inHealthCare,publishedin2003, the body of data on health care disparities is expanding. For example, a study examining treatment of adults with extremitysoft-tissuesarcomasshowedthat blacks had the lowest rates of limbpreservingsurgeriesandthehighestrates ofamputationsincomparisonwithwhite, Hispanic, andAsianpatients.Blacksalso had the lowest rates of radiation therapy used in conjunction with surgery, and when researchers controlled for factors includingage,sex, tumorsize,andtumor grade,blackpatientswere23%less likely than whites to receive radiation and surgery. (Martinez SR, et al. Cancer. 2008; 112[5]1162-1168).