Study links segregated hospital care to poorer health outcomes for Black, White patients

Racially segregated hospital care has produced more deaths and life-threatening hospitalizations for White and Black patients alike, according to a study published Wednesday.

Writing in JAMA Health Forum, six researchers from St. Louis and Minneapolis examined 2018 Medicare claims data for 4,386 hospitals across 280 metropolitan areas. 

In many cities, they found Black and White public health insurance beneficiaries received care at hospitals matching the skin color of their respective neighborhoods, resulting in “worse health outcomes” for both racial groups in more segregated hospitals.

That correlation supports emerging evidence for informal “racial segregation as a root cause of health disparities,” the researchers noted.

“Policymakers and clinical leaders could address this important public health issue through payment reform efforts and expansion of health insurance coverage, in addition to supporting upstream efforts to reduce racial segregation in hospital care and residential settings,” they wrote.

According to the study, racially divided care was most common in Midwestern hospitals, with sharper residential segregation, higher median income, more rural patients and more hospitals.

In more racially isolated hospitals, Black patients under 75 years old experienced 28% more acute hospitalizations, 15% more chronic hospitalizations and 6% more deaths per 100,000 Medicare recipients than the national median.

White patients under 75 in more segregated hospitals experienced 6% more acute hospitalizations, 8% more chronic hospitalizations and 3% more deaths than the national median.

The study noted the top five most racially segregated or “dissimilar” hospital markets, in descending order: Washington, D.C.; Detroit, Michigan; St. Louis, Missouri; Indianapolis, Indiana; and Minneapolis, Minnesota. 

The five least segregated hospital markets were all in the South: San Antonio, Texas; Orlando, Florida; Tulsa, Oklahoma; Houston, Texas; and Charlotte, North Carolina.

The findings did not include Hispanics, Asians or other races.

“For this study, we chose to focus specifically on non-Hispanic Black and non-Hispanic White segregation due to long-standing and deeply rooted anti-Black racism in the US that has and continues to impose a more rigid and persistent divide between Black and White groups than other racialized groups,” the researchers wrote.