Scientists to study racial disparity

The difference in treatment for pain between blacks and whites is striking.
ST. LOUIS POST-DISPATCH
ST. LOUIS -- A number of studies have found that blacks receive substandard treatment for pain.
Now a team of researchers at St. Louis University is examining racial differences in treatment of job-related lower back pain to try to figure out why the disparity persists.
When it comes to treatment for pain, differences between blacks and whites have been striking.
Last month, a study published in the Journal of Pain reported that 86.9 percent of pharmacies in white ZIP codes in Michigan stocked sufficient supplies of the medications compared with 54.2 percent in minority ZIP codes in the state.
Additional research
Other studies have reported that black nursing home residents were two-thirds more likely to get no treatment for pain and that two-thirds of blacks received ineffective treatment for cancer pain.
The team of researchers at St. Louis University School of Medicine will examine about 500 case records from the Missouri Division of Workers' Compensation plus depositions of people who filed claims. The four-year, $900,000 grant from the federal government will allow the researchers to study why blacks in Missouri receive less treatment for lower back pain than whites.
The study follows earlier work by the researchers in which they documented disparities in treatment for blacks and whites. They concluded that less money was spent on medical care for blacks with work-related back pain, and that blacks received smaller settlements and fewer compensated work absences for their injuries than whites.
Long-term health
Long-term health outcomes for blacks also were worse.
They interviewed about 1,500 people in St. Louis, St. Louis County and Jackson County who reported work-related back injuries and had claims settled.
The team's research has been published in several medical journals over the last year.
"What became clear was that people were being treated differently," said Raymond Tait, a professor of psychiatry at St. Louis University School of Medicine who has been studying pain issues since 1978. "We wanted to know what was going on."
By understanding the cause of disparities, researchers hope to design interventions to reduce them, Tait said.
The team chose to look at workers' compensation records because the system was designed to address work-related injuries in a standardized way, unlike health insurance coverage, which can vary widely.
Prior research
In their previous research, investigators expected to find disparities, but were surprised at the extent, Tait said.
"There were huge differences," Tait said. As a result, blacks have suffered disproportionately, physically, emotionally and financially, he said.
For example, three times as much money was spent on medical care for whites and four times as much was paid out in workers' comp disability settlements.
"It appears that if you are Caucasian with a back injury, you are four times more likely to undergo surgery," Tait said.
Researchers studied only blacks and whites because there wasn't enough workers' comp data available on other groups to be statistically reliable.
They controlled for the effect of social-economic status, such as the person's annual income and education.
"Race contributes above and beyond that," Tait said.
Negative stereotyping
Tait suspects that negative racial stereotyping is the most likely explanation for the glaring disparities. Pain is subjective, leaving plenty of room for bias, he said. A study published earlier this year in the journal pain suggested that physicians might not believe complaints of back pain from black patients.
However, a study by the St. Louis University researchers published in February found that it's cheaper in the long run to provide more equitable treatment and compensation, making it possible for more people to return to work.
"If we are going to move forward as a society, we need to be capable of doing things more equitably," Tait said. "You want people to have a fair shot. At this stage of the game, it's fairly apparent that some people do not."