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Racial and Ethnic Disparities in the VA Health Care System: A Systematic Review

Journal of General Internal Medicine volume 23, pages 654–671 (2008)Cite this article

Abstract

Objectives

To better understand the causes of racial disparities in health care, we reviewed and synthesized existing evidence related to disparities in the “equal access” Veterans Affairs (VA) health care system.

Methods

We systematically reviewed and synthesized evidence from studies comparing health care utilization and quality by race within the VA.

Results

Racial disparities in the VA exist across a wide range of clinical areas and service types. Disparities appear most prevalent for medication adherence and surgery and other invasive procedures, processes that are likely to be affected by the quantity and quality of patient–provider communication, shared decision making, and patient participation. Studies indicate a variety of likely root causes of disparities including: racial differences in patients’ medical knowledge and information sources, trust and skepticism, levels of participation in health care interactions and decisions, and social support and resources; clinician judgment/bias; the racial/cultural milieu of health care settings; and differences in the quality of care at facilities attended by different racial groups.

Conclusions

Existing evidence from the VA indicates several promising targets for interventions to reduce racial disparities in the quality of health care.

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Acknowledgments

This study was funded by and conducted for the Evidence Synthesis Activity Pilot (ESP) Program of the U.S. Department of Veterans Affairs Health Services Research and Development Service (ESP 05-225). The authors are responsible for the content of the manuscript and the decision to submit it for publication. We thank the ESP planning committee as well as content experts Judith Long, M.D., Eugene Oddone, M.D., Elizabeth Yano, Ph.D., and Donna Washington, M.D., M.P.H., for providing guidance and feedback on draft versions of the report. We are grateful to Nancy A. Brown, MLS, for designing the search strategy and conducting the literature search. Dr. Saha is supported by awards from the VA Health Services Research & Development Service Advanced Research Career Development Program, and from the Robert Wood Johnson Foundation Generalist Physician Faculty Scholars Program. Dr. Toure is supported by an award from the Robert Wood Johnson Clinical Scholars Program. Dr. Tippens is supported by the Complementary and Alternative Medicine: Expectancy and Outcomes, Project 2. Dr. Ibrahim is a recipient of a career development award from the VA Health Services Research and Development Service and the Robert Wood Johnson Foundation’s Harold Amos Faculty Development Award.

Conflict of Interest

None disclosed.

Author information

Affiliations

  1. Portland VA Medical Center, Portland, OR, USA

    Somnath Saha MD, MPH & Michele Freeman MPH

  2. Oregon Health and Science University, Portland, OR, USA

    Somnath Saha MD, MPH & Michele Freeman MPH

  3. University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Joahd Toure MD

  4. Helfgott Research Institute at the National College of Natural Medicine, Portland, OR, USA

    Kimberly M. Tippens ND

  5. Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA, USA

    Christine Weeks

  6. University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Said Ibrahim MD, MPH

  7. Center for Health Equity Research and Promotion, Pittsburgh VA Medical Center, Pittsburgh, PA, USA

    Said Ibrahim MD, MPH

Authors
  1. Somnath Saha MD, MPH
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  2. Michele Freeman MPH
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  3. Joahd Toure MD
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  4. Kimberly M. Tippens ND
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  5. Christine Weeks
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  6. Said Ibrahim MD, MPH
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Corresponding author

Correspondence to Somnath Saha MD, MPH.

Appendix

Appendix

Evidence Summary Tables

TABLE OF CONTENTS

Table 1. The use of surgery, radiation, and chemotherapy by race and cancer type .................... 2

Table 2. The use of invasive procedures for stroke among veterans, by race .............................. 3

Table 3. The use of invasive procedures for heart disease among veterans, by race..................... 4

Table 4. Potential mediators of disparities in the use of invasive procedures amomg veterans with cardiovascular disease ................ 7

Table 5. The use of colon cancer screening among veterans, by race ........................................... 9

Table 6. Management of hypertension, by race........................................................................... 10

Table 7. Management of cardiovascular risk factors (excluding hypertension), by race ............ 11

Table 8. Access to the VA healthcare system, by race ................................................................ 12

References ....................................................................................................................................13

Table 1 The Use of Surgery, Radiation, and Chemotherapy Among Veterans by Race and Cancer Type
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Table 2 The Use of Invasive Procedures for Stroke Among Veterans by Race
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Table 3 The Use of Invasive Procedures for Heart Disease Among Veterans by Race
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Table 4 Potential Mediators of Racial Disparities in the Use of Invasive Procedures Among Veterans with Cardiovascular Disease
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Table 5 The Use of Colon Cancer Screening Among Veterans, by Race
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Table 6 Management of Hypertension, by Race
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Table 7 Management of Cardiovascular Risk Factors (excluding hypertension), by Race
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Table 8 Access to the VA Healthcare System, by Race
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Saha, S., Freeman, M., Toure, J. et al. Racial and Ethnic Disparities in the VA Health Care System: A Systematic Review. J GEN INTERN MED 23, 654–671 (2008). https://doi.org/10.1007/s11606-008-0521-4

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  • DOI: https://doi.org/10.1007/s11606-008-0521-4

KEY WORDS

  • racial and ethnic disparities
  • medication adherence
  • health care utilization