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.
Similar content being viewed by others
References
Smedley BD, Stith AY, Nelson AR. Institute of Medicine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health CareUnequal treatment: confronting racial and ethnic disparities in health care. Washington, D.C.: National Academies Press; 2003.
Department of Veterans Affairs. 2001 National Survey of Veterans. Final Report. Available at http://www1.va.gov/vetdata/docs/NSV%20Final%20Report.pdf (accessed November 25, 2007).
Halanych JH, Wang F, Miller DR, Pogach LM, Lin H, Berlowitz DR, et al. Racial/ethnic differences in diabetes care for older veterans: accounting for dual health system use changes conclusions. Medical Care. 2006;44(5):439–45.
Gurmankin AD, Polsky D, Volpp KG. Accounting for apparent “reverse” racial disparities in Department of Veterans Affairs (VA)-based medical care: influence of out-of-VA care. Am J Public Health. 2004;94(12):2076–8.
Dominick KL, Bosworth HB, Jeffreys AS, Grambow SC, Oddone EZ, Horner RD. Racial/ethnic variations in non-steroidal anti-inflammatory drug (NSAID) use among patients with osteoarthritis. Pharmacoepidemiol Drug Saf. 2004;13(10):683–94.
Dominick KL, Bosworth HB, Dudley TK, Waters SJ, Campbell LC, Keefe FJ. Patterns of opioid analgesic prescription among patients with osteoarthritis. J Pain Palliat Care Pharmacother. 2004;18(1):31–46.
Dominick KL, Dudley TK, Grambow SC, Oddone EZ, Bosworth HB. Racial differences in health care utilization among patients with osteoarthritis. J Rheumatol. 2003;30(10):2201–6.
Dominick KL, Bosworth HB, Hsieh JB, Moser BK. Racial differences in analgesic/anti-inflammatory medication use and perceptions of efficacy. J Natl Med Assoc. 2004;96(7):928–32.
Golightly YM, Dominick KL. Racial variations in self-reported osteoarthritis symptom severity among veterans. Aging Clin Exp Res. 2005;17(4):264–9.
Ang DC, Ibrahim SA, Burant CJ, Kwoh CK. Is there a difference in the perception of symptoms between African Americans and whites with osteoarthritis? J Rheumatol. 2003;30(6):1305–10.
Ibrahim SA, Siminoff LA, Burant CJ, Kwoh CK. Understanding ethnic differences in the utilization of joint replacement for osteoarthritis: the role of patient-level factors. Med Care. 2002;40(1 Suppl):I44–51.
Ibrahim SA, Siminoff LA, Burant CJ, Kwoh CK. Differences in expectations of outcome mediate African American/white patient differences in “willingness” to consider joint replacement. Arthritis Rheum. 2002;46(9):2429–35.
Tan G, Jensen MP, Thornby J, Anderson KO. Ethnicity, control appraisal, coping, and adjustment to chronic pain among black and white Americans. Pain Med. 2005;6(1):18–28.
Ang DC, Ibrahim SA, Burant CJ, Siminoff LA, Kwoh CK. Ethnic differences in the perception of prayer and consideration of joint arthroplasty. Med Care. 2002;40(6):471–6.
Ibrahim SA, Siminoff LA, Burant CJ, Kwoh CK. Variation in perceptions of treatment and self-care practices in elderly with osteoarthritis: a comparison between African American and white patients. Arthritis & Rheumatism. 2001;45(4):340–5.
Knight SJ, Siston AK, Chmiel JS, Slimack N, Elstein AS, Chapman GB, et al. Ethnic variation in localized prostate cancer: a pilot study of preferences, optimism, and quality of life among black and white veterans. Clin Prostate Cancer. 2004;3(1):31–7.
Dominitz JA, Samsa GP, Landsman P, Provenzale D. Race, treatment, and survival among colorectal carcinoma patients in an equal-access medical system. Cancer. 1998;82(12):2312–20.
Dominitz JA, Maynard C, Billingsley KG, Boyko EJ. Race, treatment, and survival of veterans with cancer of the distal esophagus and gastric cardia. Med Care. 2002;40(1 Suppl):I14–26.
Akerley WL 3rd, Moritz TE, Ryan LS, Henderson WG, Zacharski LR. Racial comparison of outcomes of male Department of Veterans Affairs patients with lung and colon cancer. Arch Intern Med. 1993;153(14):1681–8.
Gordon HS, Street RL Jr., Sharf BF, Kelly PA, Souchek J. Racial differences in trust and lung cancer patients’ perceptions of physician communication. J Clin Oncol. 2006;24(6):904–9.
Gordon HS, Street RL Jr., Sharf BF, Souchek J. Racial differences in doctors’ information-giving and patients’ participation. Cancer. 2006;107(6):1313–20.
Street RL Jr., Gordon HS. The clinical context and patient participation in post-diagnostic consultations. Patient Educ Couns 2006;(in press).
Oddone EZ, Horner RD, Monger ME, Matchar DB. Racial variations in the rates of carotid angiography and endarterectomy in patients with stroke and transient ischemic attack. Arch Intern Med. 1993;153(24):2781–6.
Oddone EZ, Horner RD, Sloane R, McIntyre L, Ward A, Whittle J, et al. Race, presenting signs and symptoms, use of carotid artery imaging, and appropriateness of carotid endarterectomy. Stroke. 1999;30(7):1350–6.
Goldstein LB, Matchar DB, Hoff-Lindquist J, Samsa GP, Horner RD. Veterans Administration Acute Stroke (VASt) Study: lack of race/ethnic-based differences in utilization of stroke-related procedures or services. Stroke. 2003;34(4):999–1004.
Oddone EZ, Horner RD, Johnston DC, Stechuchak K, McIntyre L, Ward A, et al. Carotid endarterectomy and race: do clinical indications and patient preferences account for differences? Stroke. 2002;33(12):2936–43.
Ferguson JA, Adams TA, Weinberger M. Racial differences in cardiac catheterization use and appropriateness. Am J Med Sci. 1998;315(5):302–6.
Hassapoyannes CA, Giurgiutiu DV, Eaves G, Movahed MR. Apparent racial disparity in the utilization of invasive testing for risk assessment of cardiac patients undergoing noncardiac surgery. Cardiovasc Revasc Med. 2006;7(2):64–9.
Mirvis DM, Burns R, Gaschen L, Cloar FT, Graney M. Variation in utilization of cardiac procedures in the Department of Veterans Affairs health care system: effect of race. J Am Coll Cardiol. 1994;24(5):1297–304.
Maynard C, Sun H, Lowy E, Sales AE, Fihn SD. The use of percutaneous coronary intervention in black and white veterans with acute myocardial infarction. BMC Health Serv Res. 2006;6:107.
Ferguson JA, Tierney WM, Westmoreland GR, Mamlin LA, Segar DS, Eckert GJ, et al. Examination of racial differences in management of cardiovascular disease. J Am Coll Cardiol. 1997;30(7):1707–13.
Peterson ED, Wright SM, Daley J, Thibault GE. Racial variation in cardiac procedure use and survival following acute myocardial infarction in the Department of Veterans Affairs. Jama. 1994;271(15):1175–80.
Whittle J, Conigliaro J, Good CB, Lofgren RP. Racial differences in the use of invasive cardiovascular procedures in the Department of Veterans Affairs medical system. N Engl J Med. 1993;329(9):621–7.
Peniston RL, Lu DY, Papademetriou V, Fletcher RD. Severity of coronary artery disease in black and white male veterans and likelihood of revascularization. Am Heart J. 2000;139(5):840–7.
Conigliaro J, Whittle J, Good CB, Hanusa BH, Passman LJ, Lofgren RP, et al. Understanding racial variation in the use of coronary revascularization procedures: the role of clinical factors. Arch Intern Med. 2000;160(9):1329–35.
Petersen LA, Wright SM, Peterson ED, Daley J. Impact of race on cardiac care and outcomes in veterans with acute myocardial infarction. Medical Care. 2002;40(1 Suppl):I86–96.
Sedlis SP, Fisher VJ, Tice D, Esposito R, Madmon L, Steinberg EH. Racial differences in performance of invasive cardiac procedures in a Department of Veterans Affairs Medical Center. J Clin Epidemiol. 1997;50(8):899–901.
Mickelson JK, Blum CM, Geraci JM. Acute myocardial infarction: clinical characteristics, management and outcome in a metropolitan Veterans Affairs Medical Center teaching hospital. J Am Coll Cardiol. 1997;29(5):915–25.
Mirvis DM, Graney MJ. Impact of race and age on the effects of regionalization of cardiac procedures in the Department of Veterans Affairs Health Care System. Am J Cardiol. 1998;81(8):982–7.
Gordon HS, Paterniti DA, Wray NP. Race and patient refusal of invasive cardiac procedures. J Gen Intern Med. 2004;19(9):962–6.
Kressin NR, Chang BH, Whittle J, Peterson ED, Clark JA, Rosen AK, et al. Racial differences in cardiac catheterization as a function of patients’ beliefs. Am J Public Health. 2004;94(12):2091–7.
Groeneveld PW, Kruse GB, Chen Z, Asch DA. Variation in cardiac procedure use and racial disparity among Veterans Affairs Hospitals. American Heart Journal. 2007;153(2):320–7.
Collins TC, Johnson M, Henderson W, Khuri SF, Daley J. Lower extremity nontraumatic amputation among veterans with peripheral arterial disease: is race an independent factor? Med Care. 2002;40(1 Suppl):I106–16.
Bosworth HB, Stechuchak KM, Grambow SC, Oddone EZ. Patient risk perceptions for carotid endarterectomy: which patients are strongly averse to surgery? J Vasc Surg. 2004;40(1):86–91.
Oddone EZ, Horner RD, Diers T, Lipscomb J, McIntyre L, Cauffman C, et al. Understanding racial variation in the use of carotid endarterectomy: the role of aversion to surgery. J Natl Med Assoc. 1998;90(1):25–33.
Whittle J, Conigliaro J, Good CB, Joswiak M. Do patient preferences contribute to racial differences in cardiovascular procedure use? J Gen Intern Med. 1997;12(5):267–73.
Kressin NR, Clark JA, Whittle J, East M, Peterson ED, Chang BH, et al. Racial differences in health-related beliefs, attitudes, and experiences of VA cardiac patients: scale development and application. Med Care. 2002;40(1 Suppl):I72–85.
Gordon HS, Street RL Jr., Kelly PA, Souchek J, Wray NP. Physician–patient communication following invasive procedures: an analysis of post-angiogram consultations. Soc Sci Med. 2005;61(5):1015–25.
Collins TC, Clark JA, Petersen LA, Kressin NR. Racial differences in how patients perceive physician communication regarding cardiac testing. Med Care. 2002;40(1 Suppl):I27–34.
Evangelista LS, Dracup K, Doering LV. Racial differences in treatment-seeking delays among heart failure patients. J Card Fail. 2002;8(6):381–6.
Blow FC, Zeber JE, McCarthy JF, Valenstein M, Gillon L, Bingham CR. Ethnicity and diagnostic patterns in veterans with psychoses. Soc Psychiatry Psychiatr Epidemiol. 2004;39(10):841–51.
Kales HC, Blow FC, Bingham CR, Copeland LA, Mellow AM. Race and inpatient psychiatric diagnoses among elderly veterans. Psychiatr Serv. 2000;51(6):795–800.
Rosenheck R, Fontana A, Cottrol C. Effect of clinician-veteran racial pairing in the treatment of posttraumatic stress disorder. Am J Psychiatry. 1995;152(4):555–63.
Rosenheck R, Seibyl CL. Participation and outcome in a residential treatment and work therapy program for addictive disorders: the effects of race. Am J Psychiatry. 1998;155(8):1029–34.
Dolan NC, Ferreira MR, Fitzgibbon ML, Davis TC, Rademaker AW, Liu D, et al. Colorectal cancer screening among African-American and white male veterans. Am J Prev Med. 2005;28(5):479–82.
Fisher DA, Jeffreys A, Coffman CJ, Fasanella K. Barriers to full colon evaluation for a positive fecal occult blood test. Cancer Epidemiol Biomarkers Prev. 2006;15(6):1232–5.
Etzioni DA, Yano EM, Rubenstein LV, Lee ML, Ko CY, Brook RH, et al. Measuring the quality of colorectal cancer screening: the importance of follow-up. Dis Colon Rectum. 2006;49(7):1002–10.
Woodard LD, Kressin NR, Petersen LA. Is lipid-lowering therapy underused by African Americans at high risk of coronary heart disease within the VA health care system? Am J Public Health. 2004;94(12):2112–7.
Williams ML, Morris MT 2nd, Ahmad U, Yousseff M, Li W, Ertel N. Racial differences in compliance with NCEP-II recommendations for secondary prevention at a Veterans Affairs medical center. Ethn Dis. 2002;12(1):S158–S162.
Bosworth HB, Dudley T, Olsen MK, Voils CI, Powers B, Goldstein MK, et al. Racial differences in blood pressure control: potential explanatory factors. Am J Med. 2006;119(1):70.e9–15.
Lowry KP, Dudley TK, Oddone EZ, Bosworth HB. Intentional and unintentional nonadherence to antihypertensive medication. Ann Pharmacother. 2005;39(7–8):1198–203.
Woodard LD, Hernandez MT, Lees E, Petersen LA. Racial differences in attitudes regarding cardiovascular disease prevention and treatment: a qualitative study. Patient Educ Couns. 2005;57(2):225–31.
Straits-Troster KA, Kahwati LC, Kinsinger LS, Orelien J, Burdick MB, Yevich SJ. Racial/Ethnic differences in influenza vaccination in the veterans affairs healthcare system. Am J Prev Med. 2006;315375–82.
Hwang SS, Chang VT, Cogswell J, Srinivas S, Kasimis B. Knowledge and attitudes toward end-of-life care in veterans with symptomatic metastatic cancer. Palliat Support Care. 2003;1(3):221–30.
Basson MD, Gomez R, Fishman L, Panzini L. Informed consent for screening sigmoidoscopy in a Veterans Administration population. Dis Colon Rectum. 2004;47(11):1939–46.
Kemppainen JK, Levine RE, Mistal M, Schmidgall D. HAART adherence in culturally diverse patients with HIV/AIDS: a study of male patients from a Veteran’s Administration Hospital in northern California. AIDS Patient Care STDS. 2001;15(3):117–27.
Curtis JR, Park DR, Krone MR, Pearlman RA. Use of the medical futility rationale in do-not-attempt-resuscitation orders. JAMA. 1995;273(2):124–8.
Heisler M, Smith DM, Hayward RA, Krein SL, Kerr EA. Racial disparities in diabetes care processes, outcomes, and treatment intensity. Med Care. 2003;41(11):1221–32.
Heisler M, Zemencuk JK, Krein SL, Hayward RA, Piette JD, Kerr EA. Racial disparities in diabetes care processes, outcomes, and treatment intensity. In: HSR&D National Meeting; 2006; Washington, DC; 2006.
Jha AK, Stone RA, Lave J, Chen H, Klusartiz H, Volpp KG. Where do black veterans receive hospital care? Variability in disparities within the VA healthcare system. In: HSR&D National Meeting; 2007; Washington, DC; 2007.
Walsh ME, Katz MA, Sechrest L. Unpacking cultural factors in adaptation to type 2 diabetes mellitus. Med Care. 2002;40(1 Suppl)I129–39.
Agha Z, Lofgren RP, VanRuiswyk JV, Layde PM. Are patients at Veterans Affairs Medical Centers sicker? A comparative analysis of health status and medical resource use. Arch Intern Med. 2000;160(27):3252–7.
References
Dominitz JA, Maynard C, Billingsley KG, Boyko EJ. Race, treatment, and survival of veterans with cancer of the distal esophagus and gastric cardia. Med Care. Jan 2002;40(1 Suppl):I14–26.
Akerley WL, 3rd, Moritz TE, Ryan LS, Henderson WG, Zacharski LR. Racial comparison of outcomes of male Department of Veterans Affairs patients with lung and colon cancer. Arch Intern Med. 1993;153(14):1681–1688.
Dominitz JA, Samsa GP, Landsman P, Provenzale D. Race, treatment, and survival among colorectal carcinoma patients in an equal access medical system. Cancer. 1998;82(12):2312–2320.
Knight SJ, Siston AK, Chmiel JS, et al. Ethnic variation in localized prostate cancer: a pilot study of preferences, optimism, and quality of life among black and white veterans. Clin Prostate Cancer. 2004;3(1):31–37.
Oddone EZ, Horner RD, Monger ME, Matchar DB. Racial variations in the rates of carotid angiography and endarterectomy in patients with stroke and transient ischemic attack. Arch Intern Med. 1993;153(24):2781–2786.
Oddone EZ, Horner RD, Sloane R, et al. Race, presenting signs and symptoms, use of carotid artery imaging, and appropriateness of carotid endarterectomy. Stroke. 1999;30(7):1350–1356.
Oddone EZ, Horner RD, Johnston DC, et al. Carotid endarterectomy and race: do clinical indications and patient preferences account for differences? Stroke. 2002;33(12):2936–2943.
Goldstein LB, Matchar DB, Hoff-Lindquist J, Samsa GP, Horner RD. Veterans Administration Acute Stroke (VASt) Study: lack of race/ethnic-based differences in utilization of stroke-related procedures or services. Stroke. 2003;34(4):999–1004
Mirvis DM, Burns R, Gaschen L, Cloar FT, Graney M. Variation in utilization of cardiac procedures in the Department of Veterans Affairs health care system: effect of race. J Am Coll Cardiol. 1994;24(5):1297–1304.
Ferguson JA, Tierney WM, Westmoreland GR, et al. Examination of racial differences in management of cardiovascular disease. J Am Coll Cardiol. 1997;30(7):1707–1713.
Whittle J, Conigliaro J, Good CB, Lofgren RP. Racial differences in the use of invasive cardiovascular procedures in the Department of Veterans Affairs medical system. N Engl J Med. Aug 26 1993;329(9):621–627.
Groeneveld PW, Kruse GB, Chen Z, Asch DA. Variation in cardiac procedure use and racial disparity among Veterans Affairs Hospitals. American Heart Journal. Feb 2007;153(2):320–327.
Peterson ED, Wright SM, Daley J, Thibault GE. Racial variation in cardiac procedure use and survival following acute myocardial infarction in the Department of Veterans Affairs. Jama. Apr 20 1994;271(15):1175–1180.
Kressin NR, Chang BH, Whittle J, et al. Racial differences in cardiac catheterization as a function of patients’ beliefs. Am J Public Health. Dec 2004;94(12):2091–2097.
Petersen LA, Wright SM, Peterson ED, Daley J. Impact of race on cardiac care and outcomes in veterans with acute myocardial infarction. Medical Care. Jan 2002;40(1 Suppl):I86–96.
Sedlis SP, Fisher VJ, Tice D, Esposito R, Madmon L, Steinberg EH. Racial differences in performance of invasive cardiac procedures in a Department of Veterans Affairs Medical Center. J Clin Epidemiol. Aug 1997;50(8):899–901.
Maynard C, Sun H, Lowy E, Sales AE, Fihn SD. The use of percutaneous coronary intervention in black and white veterans with acute myocardial infarction. BMC Health Serv Res. 2006;6:107.
Conigliaro J, Whittle J, Good CB, et al. Understanding racial variation in the use of coronary revascularization procedures: the role of clinical factors. Arch Intern Med. May 8 2000;160(9):1329–1335.
Mickelson JK, Blum CM, Geraci JM. Acute myocardial infarction: clinical characteristics, management and outcome in a metropolitan Veterans Affairs Medical Center teaching hospital. J Am Coll Cardiol. Apr 1997;29(5):915–925.
Ferguson JA, Adams TA, Weinberger M. Racial differences in cardiac catheterization use and appropriateness. Am J Med Sci. May 1998;315(5):302–306.
Hassapoyannes CA, Giurgiutiu DV, Eaves G, Movahed MR. Apparent racial disparity in the utilization of invasive testing for risk assessment of cardiac patients undergoing noncardiac surgery. Cardiovasc Revasc Med. Apr–Jun 2006;7(2):64–69.
Gordon HS, Paterniti DA, Wray NP. Race and patient refusal of invasive cardiac procedures. J Gen Intern Med. Sep 2004;19(9):962–966.
Peniston RL, Lu DY, Papademetriou V, Fletcher RD. Severity of coronary artery disease in black and white male veterans and likelihood of revascularization. Am Heart J. May 2000;139(5):840–847.
Mirvis DM, Graney MJ. Impact of race and age on the effects of regionalization of cardiac procedures in the Department of Veterans Affairs Health Care System. Am J Cardiol. Apr 15 1998;81(8):982–987.
Ibrahim SA, Whittle J, Bean-Mayberry B, Kelley ME, Good C, Conigliaro J. Racial/ethnic variations in physician recommendations for cardiac revascularization. Am J Public Health. Oct 2003;93(10):1689–1693.
Kressin NR, Clark JA, Whittle J, et al. Racial differences in health-related beliefs, attitudes, and experiences of VA cardiac patients: scale development and application. Med Care. Jan 2002;40(1 Suppl):I72–85.
Charles H, Good CB, Hanusa BH, Chang CC, Whittle J. Racial differences in adherence to cardiac medications. J Natl Med Assoc. Jan 2003;95(1):17–27.
Evangelista LS, Dracup K, Doering LV. Racial differences in treatment-seeking delays among heart failure patients. J Card Fail. Dec 2002;8(6):381–386.
Ohldin A, Young B, Derleth A, et al. Ethnic differences in satisfaction and quality of life in veterans with ischemic heart disease. J Natl Med Assoc. Jun 2004;96(6):799–808.
Collins TC, Clark JA, Petersen LA, Kressin NR. Racial differences in how patients perceive physician communication regarding cardiac testing. Med Care. Jan 2002;40(1 Suppl):I27–34.
Gordon HS, Street RL, Jr., Kelly PA, Souchek J, Wray NP. Physician–patient communication following invasive procedures: an analysis of post angiogram consultations. Soc Sci Med. Sep 2005;61(5):1015–1025.
Bosworth HB, Stechuchak KM, Grambow SC, Oddone EZ. Patient risk perceptions for carotid endarterectomy: which patients are strongly averse to surgery? J Vasc Surg. Jul 2004;40(1):86–91.
Oddone EZ, Horner RD, Diers T, et al. Understanding racial variation in the use of carotid endarterectomy: the role of aversion to surgery. J Natl Med Assoc. Jan 1998;90(1):25–33.
Whittle J, Conigliaro J, Good CB, Joswiak M. Do patient preferences contribute to racial differences in cardiovascular procedure use? J Gen Intern Med. May 1997;12(5):267–273.
Fisher DA, Jeffreys A, Coffman CJ, Fasanella K. Barriers to full colon evaluation for a positive fecal occult blood test. Cancer Epidemiol Biomarkers Prev. Jun 2006;15(6):1232–1235.
Dolan NC, Ferreira MR, Fitzgibbon ML, et al. Colorectal cancer screening among African-American and white male veterans. Am J Prev Med. Jun 2005;28(5):479–482.
Etzioni DA, Yano EM, Rubenstein LV, et al. Measuring the quality of colorectal cancer screening: the importance of follow-up. Dis Colon Rectum. Jul 2006;49(7):1002–1010.
Bosworth HB, Dudley T, Olsen MK, et al. Racial differences in blood pressure control: potential explanatory factors. Am J Med. Jan 2006;119(1):70 e79–15.
Rehman SU, Hutchison FN, Hendrix K, Okonofua EC, Egan BM. Ethnic differences in blood pressure control among men at Veterans Affairs clinics and other health care sites. Arch Intern Med. May 9 2005;165(9):1041–1047.
Lowry KP, Dudley TK, Oddone EZ, Bosworth HB. Intentional and unintentional nonadherence to antihypertensive medication. Ann Pharmacother. Jul–Aug 2005;39(7–8):1198–1203.
Sharkness CM, Snow DA. The patient’s view of hypertension and compliance. Am J Prev Med. May–Jun 1992;8(3):141–146.
Williams ML, Morris MT, 2nd, Ahmad U, Yousseff M, Li W, Ertel N. Racial differences in compliance with NCEP-II recommendations for secondary prevention at a Veterans Affairs medical center. Ethn Dis. Winter 2002;12(1):S1–58–62.
Woodard LD, Kressin NR, Petersen LA. Is lipid-lowering therapy underused by African Americans at high risk of coronary heart disease within the VA health care system? Am J Public Health. Dec 2004;94(12):2112–2117.
Fu SS, Sherman SE, Yano EM, van Ryn M, Lanto AB, Joseph AM. Ethnic disparities in the use of nicotine replacement therapy for smoking cessation in an equal access health care system. Am J Health Promot. Nov–Dec 2005;20(2):108–116.
Ambriz EH, Woodard LD, Kressin NR, Petersen LA. Use of smoking cessation interventions and aspirin for secondary prevention: are there racial disparities? Am J Med Qual. Jul–Aug 2004;19(4):166–171.
Woodard LD, Hernandez MT, Lees E, Petersen LA. Racial differences in attitudes regarding cardiovascular disease prevention and treatment: a qualitative study. Patient Educ Couns. May 2005;57(2):225–231.
Washington DL, Villa V, Brown A, Damron-Rodriguez J, Harada N. Racial/ethnic variations in veterans’ ambulatory care use. American Journal of Public Health. Dec 2005;95(12):2231–2237.
Washington DL, Harada ND, Villa VM, et al. Racial variations in Department of Veterans Affairs ambulatory care use and unmet health care needs. Military Medicine. Mar 2002;167(3):235–241.
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
Authors and Affiliations
Corresponding author
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
Rights and permissions
About this article
Cite this article
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
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-008-0521-4