This free, monthly update synthesizes news coverage from hundreds of print and broadcast news sources related to health and health care issues affecting underserved and racial and ethnic communities.

The update also summarizes recent journal articles and other research developments in the field and features a data slide from a relevant Kaiser Family Foundation publication.

DISPARITIES IN THE NEWS

1. Diabetes among Hispanics Reaching Alarming Proportions

An article from McClatchy Newspapers discussed the growing number of Hispanics living near the U.S.-Mexico border with diabetes and some of the efforts and challenges associated with addressing the problem. 

According to article, experts note that diabetes is a growing problem for people of all demographic backgrounds, but the problem is particularly acute for Hispanics living along the U.S.-Mexico border, something Dr. Bonifacio González Castro knows all too well.  He works to educate Hispanics in Yuma County Arizona about the disease. Data from the Arizona Department of Health Services showed Yuma County had the highest diabetes rate in the state, and nearly 6 in 10 Yuma residents are Hispanic.  There are also a growing number of Hispanic teens, like 15-year old Juan Rosales, who are being diagnosed.  According to Will Humble, director of the Arizona Department of Health Services, poor nutrition and the rising number of overweight and obese children are to blame. A myriad of factors, including poverty, summer heat, unsafe neighborhoods, lack of exercise options, and fear of law enforcement explain the disparities among Hispanics living along the border, according to advocates and experts. 

To help address these challenges, the Arizona Department of Health has received some money from both the federal and state governments, but according to Mr. Humble, “The state health department needs more resources to prevent obesity and diabetes” (Inzaurralde, 12/13).

TOP

2. Decaying Neighborhoods Linked to Premature Births

A recent article in LiveScience discussed the results of a recent study that examined the relationship between abandoned buildings and premature or low birthweight babies and found that women living in neighborhoods with many dilapidated buildings and other signs of decay had higher rates of premature and low birthweight babies.

According to the article, Daniel Kruger, an evolutionary psychologist at the University of Michigan, and his colleagues analyzed data from a survey of real estate and birth records in Flint, Michigan.  Analyses were stratified by race.  For both whites and blacks, there was a significant relationship between neighborhood and birth outcomes. As Kruger noted, “The worse the neighborhood, the tighter the link between dilapidation and low birthweight and prematurity.” The relationship remained, even after controlling for parental education and insurance status.  The black population in the study were more likely to live in decaying neighborhoods. 

The results of this study have spurred the researchers to plan a more in-depth study.  Kruger said that “Further research would be necessary to investigate the physical mechanisms of this theory.”  He concluded that, “To have a healthy baby, you have to build a health environment,” (Pappas, 12/13).

TOP

3. CT Lifts Its U.S. Health Rank to No. 3 But…

Although Connecticut is ranked as one of the healthiest states in the nation, a recent article published in Hartford Business noted that its residents still face several health challenges ranging from obesity to health disparities.

America’s Health Rankings, a recent report from the United Health Foundation, ranks states based on the overall health of its population. Vermont ranked number one for the fifth year in a row and New York and New Jersey made some solid improvements in their rankings. The article pointed out that Connecticut inched from fourth to third this year.  This upward movement was driven by the state having the second to the lowest obesity rate in the country (23 percent) according to the article. Although the state is ranked one of the healthiest states in the nation, the article discusses some figures that paint a different picture. For example, despite having a number that is better than most states, during the past 10 years the number of obese adults in Connecticut increased by 188,000, and significant racial and ethnic disparities were observed. Forty percent of blacks living in Connecticut are obese, compared with 20 percent of whites. Racial and ethnic disparities were also observed in diabetes, where the diabetes rate among blacks was nearly double the rate among whites. The report also found an increase in the state’s infant mortality rate and found a higher than expected preventable hospitalizations rate.

Although there has been an increase in the obesity rate and racial and ethnic disparities in health persist, Connecticut did have some good news (Bordonaro, 12/06).

TOP

4. Tennessee Moves Up in Health Rankings

A recent article published in The Tennessean reported on improvements in the obesity, smoking, and infant mortality rates in Tennessee that led to a better ranking in this year’s America’s Health Rankings, an annual report from the United Health Foundation.

This year, Tennessee was ranked 39th compared to 42nd last year in. One area in which the state saw some improvement was in adult obesity. The adult obesity prevalence rate fell from 33 percent to 32 percent, and while this was not a drastic change, it did result in Tennessee no longer ranking as the third-fattest city.  It is not ninth.  Tennessee also saw improvements in its violent crime and infant mortality rates. Despite these improvements, the article noted that these rates are still too high. “Obviously, 39th is not where we want to stay, but seeing steady improvement is a really good sign,” said Tim F. Jones, state epidemiologist. Tennessee also reported the fifth-highest prevalence rate of adults with diabetes in the nation (11.3 percent) according to the article.

Tennessee has made some solid improvements the article points out. “It is a testament to a lot of hard work from not only lots of government agencies and communities but also individuals,” said Jones (Wilemon, 12/06).

TOP

5. US Hispanics Were At Greater Risk For H1N1 Flu During 2009 Pandemic

An article published by EurasiaReview discussed the findings from a study that sought to better understand the relationship between social factors and the incidence of influenza-like illness during a pandemic.  The results showed a significant relationship between workplace policies and structural factors and illness, and that Hispanics had a greater risk of illness.

Dr. Sandra Crouse Quinn, professor of family science and senior associate director of the Maryland Center for Health Equity at the University of Maryland School of Public Health, in collaboration with researchers from the University and Pittsburgh and the University of Georgia, analyzed data from a nationally representative sample of more than 2,000 adults to determine what impact if any, social factors such a workplace policies and household size have on the incidence of influenza-like illness.  A lack of access to sick leave, having more children, and household crowding were all found to have a significant effect on the incidence of illness.  Moreover, Hispanic ethnicity was associated with a greater flu risk, even after controlling for socioeconomic status.  Dr. Quinn concluded that “we could significantly reduce the incidence of flu, particularly among Hispanics, by creating federal mandates for sick leave that allow people to stay home from work when they need to.” 

Dr. Paula Braveman, Professor of Family and Community Medicine at the University of California, San Francisco noted that the work by Dr. Quinn and her colleagues is the first to “empirically test our conceptual model of disparities in the context of a pandemic, documenting how underlying social disparities can exacerbate the pandemic,” and that “this is a significant first step in advancing our understanding of how disparities are perpetuated and aggravated in the absence of well-conceived preventive actions” (Eurasia Review, 12/06).

TOP

6. Initiative To Push Move To Electronic Health Records

A recent article published by The Daily News (Jacksonville, NC) discussed a new initiative from the U.S. Department of Health and Human Services’ Office of Minority Health, which is aimed at helping providers in medically underserved areas transition to electronic health records.

According to the article, “medically underserved areas face special challenges in making the transition to electronic health records.”  The Patient Protection and Affordable Care Act requires providers to change from paper to electronic records by 2015, and the new initiative seeks to help encourage the proliferation of technology use for providers in small practices.  In order to be eligible to participate in the program, providers must meet 5 criteria, and selected providers will be required to submit monthly reports.  The American Health Information Management Association (AHIMA) is overseeing the effort in North Carolina.  According to Audrey Chase, the president of AHIMA, they will provide six hours of web-based training on health IT, while North Shore Medical Labs Inc. will donate the electronic health record software and services through Nortec Software Inc.

The article noted that electronic records can help facilitate the sharing of information between doctors, hospitals, and other medical facilities, and that they can help improve the efficiency of a provider’s office.  As Ms. Chase said, “The more detailed, clearly documented the information, the better the patient record and the better the care that can be provided” (Pippin, 12/05).

TOP

7. Younger Americans’ Health Disparity Gets Worse

In a recent article published by Medical News Today, the gap between the least and the most healthy is widening for Americans born after 1980.

While the baby boom generation has consistently reported better health than any other generation, today’s young adults are expected to be less healthy as they age. According to Ohio State University researcher Hui Zheng, today’s young adults are projected to experience growing health disparities in their lifetimes. “As young people today reach middle age and preceding cohorts with a smaller health gap die off, we expect health disparities in the whole population to grow even larger,” said Zheng. The Ohio State study used data from the National Health Interview Survey from 1984-2007 to investigate how the health gap varies by age and cohort.

According to Zheng, indicators of health have been on the decline for more than decade, despite advances in medicine and technology. Future research is necessary to pinpoint factors contributing to the increased health gap among younger generations and to identify potential solutions. (Nordqvist, 12/02).

TOP

8. Socioeconomic Status Main Predictor of Health Habits: Study

According to the results of a study reported on in US News & World Report, socioeconomic status may help explain racial and ethnic differences in diet, exercise and weight.

Researchers from Johns Hopkins University analyzed data from more than 4,000 people. They found that relative to whites, blacks tended to have a higher body mass index (BMI), scored lower on the U.S. Department of Agriculture’s (USDA) healthy eating index, and exercised less. However, after controlling for socioeconomic status, the difference in the health index decreased. The researchers also found that regardless of race or ethnicity, individuals with a lower socioeconomic status were more likely to be overweight. Dr. Youfa Wang, director of the Johns Hopkins Global Center for Childhood Obesity and an associate professor of International Health and Epidemiology said, “Our study shows several important findings that could help enhance the understanding of the complex factors that affect disparities in diet, exercise, and obesity across ethnic and [socioeconomic status] groups” (HealthDay News, 12/02) 

TOP

9. Report: LGBT Seniors Subjected To More Stress Than Peers

A recent article published by Windy City Times discussed some of the physical and mental challenges faced by lesbian, gay, bisexual and transgender (LGBT) seniors highlighted in a study from researchers at the University of Washington’s School of Social Work.

The study, which was funded by the National Institute on Aging, was led by Karen Fredriksen-Goldsen from the University of Washington’s School of Social Work and included researchers from several states.  The team surveyed more than 2,500 LGBT individuals aged 50-95 years, and found that LGBT adults were more likely to report being lonely, being depressed, having a disability, or engaging in binge drinking thanks their heterosexual counterparts.  The study also found that 8 in 10 LGBT adults reported being verbally and/or physically assaulted, threated with violence or with being “outed”, and/or property damaged at some point in their life.  One in five LGBT adults had not told their health care provider about their sexual orientation, and some LGBT adults reported being turned away by a health care provider after they disclosed their sexual orientation.

Professor Fredriksen-Goldsen said the disparities experienced by LGBT adults are “a major concern.” She went on to say that “prevention and intervention strategies must be developed to address their unique and mounting needs and to effectively respond to the increasing number of older adults in the community” (Demarest, 11/30).

TOP

DISPARITIES IN RESEARCH

10. Racial, Ethnic, and Insurance Status Disparities in Use of Posthospitalization Care after Trauma

According to a recent study in the Journal of the American College of Surgeons, uninsured and minority patients are less likely to receive critical posthospitalization care after a traumatic injury.

Traumatic injuries lead to over 2 million hospitalizations each year and result in significant impairments that compromise long-term health and productivity. Rehabilitation and posthospitalization care enable patients to achieve their full recovery potential. The authors of this study sought to understand how race, ethnicity, and insurance status influence the utilization of posthospitalization care after trauma. The study used 2007 data from the National Trauma Data Bank, an aggregation of medical records from over 700 trauma centers across the country. This study included 173,167 patients ages 18-64 years. Children and the elderly were excluded from this sample due to differing responses to trauma and higher insurance coverage rates than the average adult population. Patients were divided into three racial and ethnic groups:  white, black, or Hispanic. Likewise, patients were categorized into three insurance categories:  private, public, or uninsured. Discharge location was categorized into four groups: home, home health, rehabilitation facility, and nursing facility. The study found that race, ethnicity, and insurance status were predictive of the use of  posthospitalization care. Hispanics were the least likely to receive posthospitalization care of any kind and blacks were more likely to be discharged to nursing facilities to care for their disabilities instead of rehabilitation facilities to improve their health status. These racial disparities persisted across insurance status groups. Across ethnic groups, the uninsured were less likely to receive posthospitalization care than their insured counterparts. Uninsured Hispanic and black patients were discharged to rehabilitation centers only one-fifth to one-fourth as often as privately insured white patients. These findings were consistent with previous research highlighting the disparities in discharge location of traumatic brain injury patients based on race and insurance status.

In light of these findings, the researchers indicate that further studies are needed to better understand the significant barriers to posthospitalization care experienced by Hispanics and to quantify the functional deficits caused by lack of access to appropriate posthospitalization care.

(Englum BR, Villegas C, Bolorunduro O, et al. Racial, ethnic, and insurance status disparities in use of posthospitalization care after trauma. Journal of the American College of Surgeons. 2011 Dec; 213(6): 699—708).

TOP

11. The Role of Cultural Distance between Patient and Provider in Explaining Racial/Ethnic Disparities in HIV Care

A recent study published in Patient Education and Counseling found that cultural differences between patients and providers have limited impact on racial and ethnic disparities in HIV treatment.

Prior research has shown that interpersonal barriers may adversely affect quality of care for minority patients. This study sought to determine whether cultural differences between patients and their providers influenced quality of care and accounted for persistent disparities in HIV treatment. The researchers surveyed 436 patients and 45 health care providers at HIV clinics in Baltimore, Detroit, New York City, and Portland over a 9 month period. The study was limited to English speaking adults receiving care for HIV infection. Patients were asked to report their age, gender, race and ethnicity, level of education, marital status, and employment status. The study used several tools to capture additional patient covariates: health literacy, substance use behaviors, overall quality of life, depressive symptoms, and social support. The researchers included medical record data describing medication regimens and current health status. Providers were also asked to report their age, gender, race and ethnicity, and profession. The study investigated five outcome variables: perceived quality of care, trust in providers, receipt of antiretroviral (ART) therapy, adherence to ART, and viral suppression. The study found that white and minority patients reported similar cultural distance scores. While perceived cultural distance was associated with patient ratings of healthcare quality and trust in providers, it did not fully explain racial and ethnic disparities in treatment or outcomes among HIV patients. These findings are consistent with previous research and highlight the complexity of health disparities. The authors indicate that while cultural barriers exist for minority patients, they are not the most important obstacles that minority patients face in interacting with the health care system. Additional research is needed to generalize these findings beyond HIV patient populations in urban settings. (Saha S, Sanders DS, Korthuis PT, et al. The role of cultural distance between patient and provider in explaining racial/ethnic disparities in HIV care. Patient Education and Counseling. 2011 Dec; 85(3):278—284).

TOP

12. Sexual Orientation Differences in Asthma Correlates in a Population-Based Sample of Adults

A recent study published in the American Journal of Public Health found that while obesity and smoking are correlated with asthma among lesbian, gay, and bisexual (LGB) adults, depressive symptoms are an additional correlate for heterosexuals.

Prior research has found LGB populations to be especially vulnerable to chronic disease due to the physical manifestations of stress and discrimination. The study sought to understand the risk factors for an asthma diagnosis among LGB populations. The authors used 2001-2008 data from the Massachusetts Behavioral Risk Factor Surveillance System (BRFSS) to study 67,359 adults. Of this sample, 2,271 (3.4%) adults self-identified as gay, lesbian, or bisexual. The authors captured several asthma risk factors in their analysis including:  educational attainment, urban exposure, weight, smoking behaviors, access to primary care, anxiety, and depression. The outcome variable for the study was a self-reported history of an asthma diagnosis. The authors found that a larger percentage of LGB adults self-reported an asthma diagnosis compared to heterosexual individuals in the sample. For LGB individuals, current or former smoking and obesity were correlated with asthma. For heterosexual individuals, obesity and depressive symptoms in the last 30 days were correlated with asthma. In addition, for heterosexuals in the sample, being underweight reduced the risk of asthma. This study was not consistent with previous studies revealing correlations between depression and chronic disease among LGB populations.

The authors concluded that the asthma risk factors for LGB individuals are behavioral and controllable. Further research is needed to differentiate between the risk factors for childhood and adult onset asthma cases and to understand why depressive symptoms are correlated with asthma among heterosexual adults.

(Landers SJ, Mimiaga MJ, Conron KJ. Sexual orientation differences in asthma correlates in population-based sample of adults. American Journal of Public Health. 2011 Dec; 101(12): 2238—2241).

TOP

13. Access to and Use of Asthma Health Services Among Latino Children: The Rhode Island-Puerto Rico Asthma Center Study

A recent study published by Medical Care Research and Review found that Latino children living in Puerto Rico were less likely to receive regular asthma care, more likely to be hospitalized, and more likely to use the emergency room for asthma care compared to Latino children living in the continental United States.

The authors of this study sought to understand the differences in health care access and utilization between Latino children residing in Puerto Rico and children of Puerto Rican and Dominican origin residing in Rhode Island. The study sampled 804 children with persistent asthma between the ages of 7-15, approximately half residing in Puerto Rico and half residing in Rhode Island. Of the children living in Rhode Island, 112 were of Puerto Rican descent, 136 were Dominican, and 151 were non-Latino white (NLW). The main outcome variables were access to care (having a consistent asthma provider) and level of health care utilization (number of asthma-related hospitalizations and emergency room visits). The researchers included a variety of mitigating factors that might influence asthma care including:  place of birth, parent’s English proficiency, income, insurance coverage, and the severity of asthma symptoms. The study found that children living in Rhode Island had more consistent access to care, were less likely to be hospitalized, and were less likely to visit the emergency room due to asthma, compared to their peers living in Puerto Rico. Children living in Puerto Rico remained vulnerable, even after controlling for factors such as asthma severity, income, and insurance status. The authors largely attributed the disparities to difference between the health care systems in Rhode Island and Puerto Rico. The findings of this study are consistent with previous research highlighting the existence of disparities both between and within ethnic groups.

The authors concluded that even after controlling for a number of factors, Latino children living in Puerto Rico remain vulnerable. Future research is necessary to understand how the Puerto Rican health care system can be improved to better meet the needs of asthmatic children.

(Jandasek B, Ortega AN, McQuaid EL, et al. Access to and use of asthma health services among Latino children:  the Rhode Island-Puerto Rico Asthma Study Center. Medical Research and Review. 2011 Dec; 68(8): 683—698).

TOP

14. Particulate Air Pollution and Socioeconomic Position in Rural and Urban Areas of the Northeastern United States

A recent study published in the American Journal of Public Health found low socioeconomic and racial minority status to be associated to increased exposure to air pollution.

This study sought to understand the relationship between socioeconomic status and air pollution levels for census tracts in Connecticut, Massachusetts, New Jersey, New York, Pennsylvania, and Rhode Island. Researchers gathered socioeconomic and population density data from the 2000 US Census. Indicators of socioeconomic status for each census tract included:  measures of poverty, educational attainment, household income, and racial minority composition. The outcome variable of interest was the annual level of outdoor particulate air pollution. The study found low socioeconomic status and racial minority composition to be associated with small, but significant increases in annual air pollution exposure. Contrary to previous research, this study found that at the census tract level large-scale pollution sources, such as factories, contributed more to annual air pollution levels than local pollution sources, such as traffic and bus depots.

Further research is needed to better understand the relationship between socioeconomic status and air pollution levels for smaller geographic areas and to generalize the results beyond the Northeast. Additional research is also needed to determine the long term health impact of the elevated air pollution exposure experienced by minority and low income populations.

(Brochu PJ, Yanosky JD, Paciorek CJ, et al. Particulate air pollution and socioeconomic position in rural and urban areas of the Northeastern United States. American Journal of Public Health. 2011 Dec; 101 (S1): 224—230).

TOP

15. Racial and Ethnic Disparities in Diabetes Risk After Gestational Diabetes Mellitus

A recent study published in Diabetologia found black women in Southern California who had Gestational Diabetes Mellitus (GDM) had the highest risk of developing diabetes after a pregnancy than any other racial and ethnic group.

Prior research has indicated that Asian and Pacific Islander women have the highest prevalence of GDM. In contrast, the prevalance of GDM among black women tends to be relatively low. Using data from multiple sources, the researchers sought to determine whether there are racial and ethnic differences in women who had GDM during a pregnancy and later developed diabetes. The study included women who had GDM and a singleton delivery at 20 weeks gestation or later—without having type 1 diabetes and/or existing diabetes before the study—at a Kaiser Permanente hospital in Southern California between January 1st 1995 and December 31st 2008. Approximately 2,600 women developed diabetes after their pregnancy. Among them were 456 white, 1,464 Hispanic, 309 black, 403 Asian or Pacific Islander women, and 25 women whose race or ethnicity were "other." Consistent with other research, Asian and Pacific Islander women in the study had the highest prevalence of GDM. However, they had the same risk of developing diabetes as white women. Black women with GDM had the highest rate of being diagnosed with diabetes after having had GDM than any other racial and ethnic group according to the findings—a total of 29 cases per 1,000 persons a year. This rate was nine times greater than black women of similar age without GDM. Age, parity, education, comorbidity status and BMI were not significant in predictors for developing diabetes in the future. The authors suggested future research will have to explore if the environment, genetics, or other possible factors can explain why black women with GDM have a higher risk of developing diabetes. This study highlights why it is important for a doctor to take into account a patient’s race and/or ethnicity during a counsel session about the risk of diabetes after GDM according to the authors. They argue that there should be more effective diabetes screening and prevention programs for women with GDM, especially for black women. (Xiang AH, Li BH, Black MH, et al. Racial and ethnic disparities in diabetes risk after gestational diabetes mellitus. Diabetologia. 2011 Dec; 54(12): 3013—3021).

TOP

16. Differences in National Antiretroviral Prescribing Patterns Between Black and White Patients with HIV/AIDS, 1996—2006

A recent study published in the Southern Medical Journal found the differences in use of highly active antiretroviral therapy (HAART) regimens between black and white HIV/AIDS patients by 2006 was no longer significant, suggesting HAART has been effectively disseminated in more recent years. Antiretroviral therapy has been proven to reduce HIV/AIDS related- morbidity and mortality outcomes. However, disparities between black and white HIV/AIDS patients persist. The authors in this study wanted to determine whether there are utlization differences of HAART regimens between black and white HIV/AIDS patients. They used data from the 1996-2006 National Hospital Ambulatory Medical Care Surveys (NHAMCS), which is a national survey designed to collect data on the utilization and delivery of ambulatory care services in non-federal hospital emergency and outpatient departments. Demographic characteristics of interest included age, race, sex, year of ambulatory visit, insurance status, geographic region, and type of antiretroviral medication. Individuals younger than 18, those who had no documentation of antiretroviral therapy, and those who did not identify as black or white were excluded from the study. The variable of interest was whether race had an influence on the usage of HAART regimens. A total of 2,970,222 patient visits met the study inclusion criteria; 58% were black and 42% were white. The results indicated that blacks were proportionally less likely to use HAART and protease inhibitors (PIs) than whites; however, a higher proportion of them used non- nucleoside reverse transcriptase inhibitors (NNRTIs). The authors further found race was not significantly associated with the use of HAART regimens, while the year of ambulatory visit and insurance status were predictors. For example, blacks were far less likely to use a HAART regimen earlier in the study; however, that disparity dissipated by 2002. The authors explain that HAART being distributed and targeted effectively after the combination of treatment was recommended for routine practice as an explanation. They further suggest that the study highlights that blacks are not as disadvantaged for using antiretroviral therapy as a decade ago. However, they did add blacks still do not experience optimal benefits from antiretroviral therapy and future research will have to explore why. The authors emphasized that the results contradict current theories that the disparity in optimal health outcomes between blacks and whites is a result of a lack of use of antiretroviral therapy. However, they point out that this study did not explore possible socioeconomic and other risk factors that are associated with the black population and lack of optimal benefit. (Oramasionwu CU, Brown CM, Lawson KA, et al. Differences in national antiretroviral prescribing patterns between black and white patients with HIV/AIDS, 1996-2006. Southern Medical Journal. 2011 Dec; 104(12): 794—800).

TOP

17. Within-Group Differences Between Native-Born and Foreign-Born Black Men on Prostate Cancer Risk Reduction and Early Detection Practices

A recent study published in the Journal of Immigrant and Minority Health found foreign-born black men were more than likely to have lower knowledge about prevention and detection of prostate cancer despite having higher educational levels, income, and conversations about prostate cancer with their physician than U.S. born black men.

The number of foreign-born blacks in the last two decades has more than tripled. The authors argue that by grouping foreign-born and US-born blacks together for health disparities research limits the ability to address the particular needs of a subgroup. They also point out that prostate cancer (CaP) has disproportionately affected black men than any other racial and ethnic group in the nation. The purpose of this study was to explore ethnic variations among native and foreign born black men relative to CaP risk reduction and early detection behaviors. They specifically wanted to explore the differences between black men who were born in Africa, the Caribbean, or the US. The independent variable and outcome of interest was whether nativity had an effect on CaP risk reduction and early detection behaviors. Specifically the behaviors included having a discussion about CaP with a physician, CaP screening by digital rectal ecam (DRE) and by prostate specific antigen (PSA). The participants were randomly selected from a variety of locations (e.g. barbershops and organized health events/meetings) in the cities of Tallahassee, the Tampa Bay area, Miami, Jacksonville and Orlando. The collection of data began in April 2008 and ended in October 2009. A total of 3,040 participants completed the interview about their nativity, knowledge of CaP, and other risk reduction factors, eg diet and chemoprevention. A total of 2,405 participants were US-born, 315 were African-born, and 320 were Caribbean-born. The results indicated that both African and Caribbean born men ate meat less often and in smaller portions than US born black men. The consumption of meat was important for data analysis because the authors pointed out that a greater consumption of meat was linked to an increase risk for CaP and advanced CaP. The findings further demonstrated that African-born men had a higher rate of having a discussion about CaP preventive measures with their physicians than US and Caribbean born black men. However, despite the higher rates, they reported a lower knowledge about the risks of CaP. These disparities highlight the importance of gaining data about particular health needs across different black subgroups in the United State according to the authors. The authors argue that future studies and programs will have to explore the health impact of acculturation on foreign-born black men to better understand their health needs, especially with the increasing number of black immigrants to the US. (Odedina FT, Dagne G, LaRose-Pierre, M, et al. Within-group differences between native-born and foreign-born black men on prostate cancer risk reduction and early detection practices. Journal of Immigrant Minority Health. 2011 Dec; 13(6): 996—1004).

TOP

18. Colorectal Cancer Screening Disparities in Asian Americans and Pacific Islanders: Which Groups Are Most Vulnerable?

A recent study published in Ethnicity & Health found a disparity in the rate of colorectal cancer (CRC) screenings across Asian American and Pacific Islanders (AAPI) in California and suggest accurate recording of ethnic identity by health professionals are required to reduce CRC disparities.

Prior research has focused largely on the disparity between non-Hispanic whites and aggregated AAPI. The authors point out that when AAPI are disaggregated, disparities tend to emerge across the ethnic subgroups. The purpose of this study was to explore the rate of CRC screenings among seven different AAPI subgroups—Chinese, Koreans, Japanese, South Asians, Vietnamese, Filipinos, and Pacific Islanders—in order to identify which groups are less likely to access care and receive this medical procedure. The authors proposed two research questions, 1) what are the CRC screening differences between AAPIs and within AAPIs, and 2) is the ethnic variation a predictive variable for CRC screening, even after controlling for predisposing, enabling, and need factors? They used a merged data file from the 2001, 2003, and 2005 California Health Interview Health Survey (CHIS), which they focused largely on the questions concerning information around cancer screening, health care access, and immigration background. Eligibility included persons who were at least 50 years of age and either white or an ethnic variation of AAPI. The three-year merged data provided a sample size of 48,004 white participants and 4,487 AAPI participants. The outcome of interest was whether or not ethnic variation among AAPIs predicted a CRC screening within the past five years. The findings demonstrated whites had a 10% higher screening rate (57.7%) than AAPIs grouped together. Additionally, the disparity between whites and AAPIs persisted even after adjusting for potential confounders. However, when AAPIs were disaggregated, the CRC screening rate varied across the different ethnic subgroups. For example, Japanese had the highest CRC screening rate (59.8%) while Koreans had the lowest (32.7%). This variation among the subgroups displays the remarkable contrast that exists within different racial and ethnic subgroups according to the authors. Overall, Filipinos, Koreans, Pacific Islanders and South Asians were less likely to obtain a CRC screening in the past five years than Chinese, Japanese, and Vietnamese. This was further prevalent after they adjusted for potential confounders, where Filipinos, Koreans, and South Asians were all significantly less likely to receive a CRC screening in the past five years. The authors say that this study further adds to the growing literature by providing valuable statistics on how race/ethnicity factors into cancer screenings.  

Prior literature has proven success with community-based educational programs for cervical and breast cancer screenings. The authors argue that the findings of this study indicate adopting this type of policy for CRC would be beneficial. For example, creating CRC screening interventions that target the most vulnerable, disadvantaged, and underserved AAPIs.

(Lee HY, Lundquist M, Ju E, et al. Colorectal cancer screening disparities in Asian Americans and Pacific Islanders: which groups are most vulnerable?. Ethnicity & Health. 2011 Dec; 16(6): 501—518).

TOP

19. Rurality and Nursing Home Quality: Evidence From the 2004 National Nursing Home Survey

A recent study published in The Gerontologist found rural nursing home residents tend to have higher hospitalization rates and experience higher levels of moderate to severe pain.

According to the authors, urban-rural disparities in health status and access to care have been well documented. Prior research has further indicated poorer quality of care in rural long-term care facilities compared to urban facilities. This has provided some examples of rural residents having an increased risk of multiple hospital admissions. The purpose of this study was to explore what relationship rurality has with the quality of care in nursing home. The study used data from the 2004 National Nursing Home Survey, a national survey that gathers health information from nursing homes, residents, and staff. The variables of interest consisted of facility metropolitan statistical area (MSA) measurements: metropolitan, micropolitan, and rural areas. Four variables were used to measure the quality of care of a nursing home facility: 1) hospital admission in the past 90 days, 2) vaccination status among residents in the past twelve months, 3) resident’s documented vaccination status, and 4) level of pain in the past seven days. The sample of the study included over 12,000 residents aged 50 years and older from over 1,000 facilities. The metropolitan facilities included 6,959 residents, micorpolitian areas included 2,851 residents, and 2,697 residents were located in a rural area.  The findings showed residents located in rural areas tended to have lower income levels, which also tended to show a greater dependence on government programs like Medicare and Medicaid. Additionally, rural residents tended to be admitted to a hospital within 90 days and experience higher levels of moderate to severe pain than those from a metropolitan area. Furthermore, they were more likely to be admitted to nursing homes without accreditation, which have been found to lack special care programs. This finding was consistent with the literature, that rural facilities tend to provide poorer quality of care than a metropolitan area and lack special care programs. These disparities persisted even after controlling for individual and facility level factors, such as revenue sources, staffing levels, Medicare payments, and age.

The authors provide a number of policy recommendations based on the findings. For example, policies that are geared towards rural nursing home facilities should implement appropriate programs that train and retain staff members and as well as offer special care programs, which more than likely reduce health disparities among rural nursing homes according to the authors.    

(Kang Y, Meng, Hongdao M, Miller NA. Rurality and nursing home quality: evidence from the 2004 National Nursing Home Survey. The Gerontologist. 2011 Dec; 51(6): 761—773).

TOP

20. Environmental Health Disparities in Housing

A recent supplement published in the American Journal of Public Health discussed some of the factors and associations that residential housing play into racial and ethnic health disparities.

The literature in the field has consistently demonstrated a link between housing and a person’s health according to the author. Furthermore, disparities in health are largely attributable to housing-related disease, injury, or both. The author of this supplement reviewed a number of articles and surveys, such as the American Housing Survey (AHS), the National Health Nutrition Examination Survey (NHANES), and articles found through PubMed that discussed a number of themes about the relationship of housing and health that are consistent across the literature. The author goes into detail explaining recent evidence exploring this relationship. For example, he discussed how one study explored housing segregation and its effect on a person’s health. This study found that the experimental group—those who were offered Section 8 vouchers that could be used only in a low-poverty, mixed income neighborhood—fared better than the comparison and control group—those who only could live in a segregated housing neighborhood (comparison) or were not offered a section 8 voucher (control). This study found that the experimental group reported an 11% reduction in obesity and better health outcomes than the two other groups. The author further points out that there is not a longitudinal integrated representative housing and health population-based survey despite the vast amount of literature claiming inequities in housing has a significant relationship with health disparities. This, he explains, is problematic and is one possible solution to fixing these disparities across all racial and ethnic groups.

The author also provides a number of other policy recommendations, such as an increased investment in research that explores this relationship and creating a unified healthy housing research agenda. These are just a few recommendations that could potentially serve as effective interventions he argues.

(Jacobs DE. Environmental health disparities in housing. American Journal of Public Health. 2011 Dec; 101(S1): 115—122).

TOP

DISPARITIES DATA SPOTLIGHT

SOURCE: KFF Webcast:  New CMS Estimates of State-by-State Health Expenditures

The Centers for Medicare and Medicaid Services recently released data on health care expenditures by state. Health care spending in the United States varies greatly by region and by income. Over the last ten years, states in the Mideast and New England regions had the highest per capita spending. According to 2009 estimates, Massachusetts spent the most on personal health care per capita at $9,278 per resident (136% of the national average). States in the Southwest and Rocky Mountain regions had the lowest per capital spending. In 2009, Utah had the lowest per capita health care spending at $5,031 per resident (74% of the national average). These new CMS estimates have implications for several provisions of the Affordable Care Act and will likely inform policies designed to control health care spending.

To learn more about how much Americans spend on health care across the country, please visit Webcast: New CMS Estimates of State-by-State Health Expenditures.