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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. 1. Medicare Doesn’t Cover Many Health-Care Expenses for Low-income Seniors DISPARITIES IN RESEARCH
9. Medicaid Payment Levels to Dentists and Access to Dental Care Among Children and Adolescents 14. Racial Variation in Breast cancer Treatment Among Department of Defense Beneficiaries DISPARITIES DATA SPOTLIGHT Medicare Households Just Above the Poverty Level Spend a Greater Share of Their Household Budgets on Health Care than the Poorest and Highest-Income Medicare Households DISPARITIES IN THE NEWS 1. Medicare Doesn’t Cover Many Health-Care Expenses for Low-income Seniors An article in the Washington Post reported on the challenges low-income Medicare beneficiaries will face covering the increased costs being proposed in several solutions to the Medicare solvency problem. Using Medicare survey data, researchers at the Kaiser Family Foundation found that approximately half of all Medicare recipients have incomes at or below 200 percent of poverty, which equates to $21,780 for an individual or $29,420 for a couple, while only 5 percent of have incomes at or above $80,000. Beneficiaries with incomes close to poverty, tend to spend almost 25 percent of their income on health care. Medicare is an entitlement program for seniors and people with certain disabilities, and it accounts for 15 percent of the federal budget. Several proposals aimed at addressing the rising health care costs include the Republican plan sponsored by Rep. Paul Ryan (R-Wis.) which would double out-of-pocket health-care spending to $12,500 per year, according to estimates by the Congressional Budget Office. “Many [seniors] live on a fixed income, struggling to make ends meet…with really limited capacity to absorb rising costs,” said Tricia Neuman, director of the Kaiser Family Foundation’s Medicare Policy Project (Aizenman 7/18). 2. A Vaccine May Shield Boys Too An article in The New York Times reported on the potential benefits of Gardasil, the only FDA approved Human papillomavirus (HPV) vaccine for young men and women, for men. Gardasil, mainly used by young women, protects against four strains of sexually transmitted HPV strains of which two can lead to cancer of the cervix, vagina, and vulva. The vaccine, administered in three shots, can cost up to $400 if paid out-of-pocket. Until recently, it was thought that men would receive little benefit from the vaccine. However, researchers have found that men who receive complete the series of three shots have a reduced risk of genital warts, and recent data on men who have sex with men indicate that Gardasil may also protect from high-grade precancerous anal lesions. There are 5,820 new cases of anal cancer diagnosed each year with 3,680 of them in women. These findings have led Merck, the maker of the vaccine, to push to get more boys vaccinated. However, with modest benefits to young men, parents are reluctant to vaccinate their sons. “You do a public service by getting your child vaccinated,” said Jane Kim, an assistant professor at Harvard School of Public Health. Gardasil has been tested for safety in 1,000 boys under the age of 16, and in a trial of 4,055, the most common side effects were headache, fever, and pain, itching, redness, swelling, and bruising. Cervarix, another HPV vaccine against cervical cancer has not been tested in boys (Rabin 7/18). 3. Rural-Urban Health Insurance Cost Disparity Rises A recent article from The Des Moines Register discussed the findings of a study from the annual Iowa Employer Benefits Study, which found that rural residents were more likely to pay higher health insurance fees compared to urban residents. The health status of rural Iowan residents was published by The Real Iowans Health Survey (Belz 7/16). 4. Health Care Disparities at Issue in Abortion Rates among Black Americans A recent article published in the Oakland Tribune reported on controversial anti-abortion billboards that are targeting black women in California. Nationwide, African-American women have abortions almost five times more than white women. Furthermore, the CDC reported in 2006 that 45.9 abortions per 100 births are among African American women while 16.2 are among white women. Some advocacy groups are saying these statistics amount to “genocide” in the black community. According to the article, Issues4Life, an anti-abortion, has angered various community members and pro-choice groups in America because of their controversial billboards posted around the country. Lupe Rodriguez, a spokeswoman for the Alameda County branch of Planned Parenthood, said the billboards are “reprehensible, and disrespectful to the African-American community.” Other abortion and women rights groups say such tactics are inflammatory, racist, and demeaning to the black community, noting that they simplify a very complex issue. Rodriguez says “They’re trying to single out one part of the overall health care of that community, and using a wedge issue to divide people.” Some experts, like Rodriguez, claim the statistics reveal the larger issue, access barriers the black community faces. “It really boils down to people not having access to care, not being able to prevent those unintended pregnancies,” said Rodriguez. (Johnson, 7/14). 5. Minorities Lag in Mental Health Treatment, But Some are Working to Change That A recent article in the Detroit Free Press discussed the obstacles and stigma associated with mental health treatment for minorities and what some groups are doing to change it. According to the article, the major barriers for minorities accessing mental health treatment include costs, transportation, lack of familiarity with available resources and possible languages barriers. However, according to the article, another predominant reason why minorities may not receive or seek to receive mental health treatment is due to the stigma attached to such services. “My opinion is that the stigma associated with mental illness compounds the racial and ethnic issues that impact the African-American experience in our country,” said Veda Sharp, executive director of the Detroit-Wayne County Community Mental Health Agency. In light of the barriers and stigma associated with mental health treatment, the article points out a group in Detroit who are attempting to change all of that. Marilyn Snowden and other summer organizers at the Detroit East Community Mental Health Center planned an event on July 9 to promote the good in mental health treatment and services. “We want people to see mental health facilities as a place open to everyone, not a place people should be frightened to come to,” said Snowden. Dr. John Dziuba, chief psychiatry at Sinai-Grace Hospital in Detroit, was mentioned in the article addressing the fact that mental illness is as disabling as cancer and heart disease and minorities in need of such services must seek them out. “More people die from suicide than breast cancer. But mental illness, a major factor in suicides, is not at the forefront of people’s awareness,” said Dziuba. Experts agree according to the article, initiatives that bring awareness to minorities in need of seeking mental health treatment are best. For example, in 2008, the U.S. House of Representatives designated July as National Minority Mental Health Month. (Spratling, 7/16). 6. Adult Obesity Increases in 16 States A recent article in The Washington Post discussed the released report from the Trust for America’s Health and the Robert Wood Johnson Foundation about the increasing rate of adult obesity in America. The recent report, “F as in Fat: How Obesity Threatens America’s Future,” gave some sobering facts regarding adult obesity in America. For example, in the past two decades, the obesity rate in 38 states has increased to 25 percent, whereas no state twenty years ago was above 15 percent. Oklahoma, Alabama, and Tennessee had the fastest growing obesity rate in America. Furthermore, significant disparities were also highlighted in the report. For example, obesity figures are much higher for people who are less educated, who have less money, and are of color. The article mentioned another unfortunate fact from the report that no state has had a backward trend of obesity rates. However, the District of Columbia, Colorado, and Connecticut had the slowest obesity rates in the country. Jeff Levi, executive director of the Trust for America’s Health, said “Today, the state with the lowest obesity rate would have had the highest rate in 1995.” (Sun, 7/7). 7. Study in D.C. Hospitals Identifies Factors for Disparity in Stroke Treatment for Blacks A recent article published in The Washington Post reported on a study of District residents hospitalized for a stroke, that found blacks were less one-third likely to receive lifesaving treatment compared to whites. According to a study published in the journal Stroke, there is a significant disparity in hospitalizations for a stroke between blacks and whites in the District of Columbia. Another study, conducted by a consortium of University Hospitals in the District that was also discussed in the article, found that only 3 percent of black patients were treated with the clot busting treatment tPA, compared to 10 percent of white patients who were treated with tPA. The article did discuss a study that controlled for possible racial bias by primary care providers. The researchers in that study followed 45 patients who received this lifesaving treatment (tPA). Out of the followed patients, seventy percent of the makeup were black as compared to seventy-six were white. Amie Hsia, the lead author and medical director of Washington Hospital Center’s Stroke Center, said “this data provides enough information to rule out racial bias.” Even as racial bias can be ruled out, the researchers suggest, however, blacks on average are still less likely to receive the lifesaving treatment for a stroke compared to whites. Dr. Hsia went on to say, “Based on our data, it appears that much of the explanation is due to things that happen before the patient gets to the hospital.” Other researchers agree that certain factors, such as not arriving at the hospital early enough and having high blood pressure, are the major reasons why blacks may not receive the life saving medical treatment for a stroke. According to the article, patients must call 911 at first sight of symptoms and control other risk factors such as high blood pressure in order to receive this treatment and prevent such ruling out factors. (Sun, 6/30). RESEARCH 8. Association of Race and Sites of Care With Pressure Ulcers in High-Risk Nursing Home Residents The Journal of American Medical Association published a study that examined the prevalence of pressure ulcers among high-risk long-term care residents, and found that black residents were more likely to be diagnosed with pressure ulcers compared to white residents. Using data from the Minimum Data Set (MDS) files for nursing homes from 2003 through 2008, the authors identified 2.1 million non-Hispanic white and 346,808 black residents who were at high risk for pressure ulcers. The characteristics of 12,473 nursing homes were also obtained to identify potential differences in pressure ulcer rates among sites of care. Unadjusted analyses found that black residents were more likely to have stage 2 pressure ulcers compared to non-Hispanic white residents, 15.9% vs. 10.5% respectively. From 2003 to 2008, among low-risk long-term residents, whites had a higher prevalence rate than black residents to which the authors attributed the lower rates among blacks to under-identification due to darkly pigmented skin. Racial disparities persisted among residents diagnosed with pressure ulcers that were stage 2 or greater. From 2003 to 2008, the prevalence rate of pressure ulcers for both black and non-Hispanic white residents decreased; however, racial disparities persisted, with an unadjusted disparity rate of 5.4% in 2003 and 5.0% in 2008. Furthermore, risk-adjusted disparities with sites of care were also found between sites. In nursing home sites with a higher concentration of black residents (>35%), both black and non-Hispanic white residents were more likely to have higher rates of pressure ulcers than nursing home sites with mostly non-Hispanic white residents (<5%). The authors noted that racial disparities were largely associated with the type of facilities and that the nursing home where a patient is served is more important than the patient’s race itself, suggesting that policy interventions to target disparity-eliminating efforts. 9. Medicaid Payment Levels to Dentists and Access to Dental Care Among Children and Adolescents The Journal of American Medical Association published a study that examined the relationship between state Medicaid dental fees and children’s receipt of dental care and found that higher Medicaid payments to dentists were associated with increase receipt of dental care among children. Using Medicaid survey data from the Lewin Group and the Urban Institute, the authors identified provider payment rates for various dental services in 2000 and 2008. Medicaid fee data and data from the National Health Interview Survey were used to determine whether a child had seen a dentist in the past 6 months in a sample size of 33,657 children and adolescents aged 2 through 17 years of age. Medicaid prophylaxis fees varied from a low of $20 in New Jersey to a high of $45 in Alaska and the mean fee difference in 2000-2001 ($28.95) and 2008-2009 ($29.98) was not statistically significant. The authors noted that receipt of dental care varied by type of insurance company. In 2008, children with private insurance coverage were more likely to see a dentist in the past 6 months than children in Medicaid. However, Medicaid-covered children and adolescents were more likely to see a dentist than the uninsured. Poverty status, race/ethnicity, age, and gender were contributing factors to likelihood of seeing a dentist in the past 6 months. Poorer children, being black or Hispanic, between ages 2 and 6 years, and male were all predicting factors of not seeing a dentist in the past 6 months. Furthermore, a positive correlation was found between Medicaid payment levels on states and children’s use of dental care. Using hypothetical models, the authors found that increasing payment level is associated with an increase in the chance that a child covered by Medicaid had seen a dentist. The authors noted that although the Patient Protection and Affordable Care Act authorizes and increase in Medicaid fees for primary care physicians, more attention is warranted for dental care. (Decker SL. Medicaid payment levels to dentists and access to dental care among children and adolescents. JAMA. 2011 Jul 13; 306(2): 187-93). 10. Gender Disparities in Lipid-Lowering Therapy Among Veterans With Diabetes The results of a recent study published in Women’s Health Issues found that women veterans had higher lower density lipoprotein cholesterol (LDL) levels than veteran men and were less likely to initiate or receive therapy than their male counterparts. Using data from the Veterans Health Administration (VHA) Diabetes Epidemiologic Cohort database, a dataset which includes information on all VHA diabetic patients since 1998, the authors identified a final study population of 22,475 women and 89,431 men with diabetes and hyperlipidemia during the 2006 fiscal year. The authors found that women were more likely to have higher mean value of LDL than men at every age group, although both men and women had a similar number of LDL tests in the study year. LDL values for younger women (under 45 years of age) were worse than younger males, and were less likely to receive a prescription for lipid-lowering medication compared to women 65 years or older. Initiation of lipid-lowering therapy was also lower for women compared to men, 37% vs. 42% respectively. After adjustments, the authors found that the odds of being of therapy was 21% lower for women as compared with men, with the odds ratio being higher (50%) for women younger than 45. The authors noted that the high proportion of young women with lack of treatment may experience a long period of exposure to the adverse cardiovascular effects of hyperlipidemia and intervening at early stages can have a positive impact on long-term health and economic costs among the diabetic population. (Vimalananda VG, Miller DR, Palnati M, et. al. Gender disparities in lipid-lowering therapy among veterans with diabetes. Womens Health Issues. 2011 Jul-Aug; 21(4 Suppl): S176-81). 11. Impact of Perceived Discrimination in Healthcare on Patient-Provider Communication A recent study published in the journal Medical Care examined the relationship between perceived discrimination and patient-provider communication, and found disparities in perceived racism and classism as well as disparities in the relationship between perceived racism and perceived classism and doctor-patient communication. This study explored the perception of discriminatory care between a patient and provider. The researchers hypothesized that a person may feel discriminated by race or class. The study collected survey data of 353 patients before and after their experience with a provider. Furthermore, the researchers also observed video footage of patient-provider interactions during each medical session. T he results showed that both black and white patients felt discriminated by their provider. Blacks felt discriminated when the provider exhibited negative non-verbal affective communication. When information and ease of communication was difficult, white patients felt discriminated. The researchers suggest that the data underlines the critical role of provider communication and how a patient perceives their care. The researchers suggest that new training programs should be initiated for doctors so that they know how to improve their communication and consider the needs of the patient more thoroughly. (Leslie R. M. Hausmann, PhD, Michael J. Hannon, MA, Denise M. Kresevic, RN, PhD, et. al. Impact of perceived discrimination in healthcare on patient-provider communication. Medical Care Volume 49, Number 7, July 2011; 626-633). 12. Self-reported Racial Discrimination in Health Care and Diabetes Outcomes A recent study published in the journal Medical Care found a significant relationship between self-reported racial and ethnic discrimination in health care and adverse health outcomes among diabetic patients. The researchers sought to explore the possible association between diabetic outcomes and patients who self-report racial and ethnic discrimination in health care. The researchers’ hypothesized that patients who self-report racial and ethnic discrimination will have lower quality care, lower self-management behaviors, and more diabetic complications. Their findings confirmed their initial hypothesis with the exception of lower self-management. Despite the significant relationship between high reported racial and ethnic discrimination and lower quality care and increase diabetic complications, self management (e.g. attending a diabetes class, having foot examinations, and checking blood sugar levels once a day) was equal across all groups who reported high and low discrimination. The researchers also found that those who reported high levels of discrimination were likely to be non-white participants. However, after the researchers adjusted for community health status, access to care, sociodemographic factors, and geographic region, the disparity of diabetic health outcomes between white and non-white participants who self reported discrimination substantially decreased. They suggest that other factors, such as race and insurance coverage, play an equal role in adverse diabetic outcomes and discrimination. According to the researchers, the data suggests that a more comprehensive strategy may need to take place in order to address health disparities among diabetic patients. (Monica E. Peek, MD, MPH, Julie Wagner, PhD, Hui Tang, MS, MS, et. al. Self-reported racial discrimination in health care and diabetes outcomes. Medical Care. 49(7); July 2011: 618-625). 13. Effects of Individual-Level Socioeconomic Factors on Racial Disparities in Cancer Treatment and Survival A recent study published in the journal Cancer found that racial disparities in cancer treatment and survival outcomes persisted even after controlling for socioeconomic variables. The researchers in this study wanted to explore the topic of racial disparities on an individual level with cancer treatment and possible survival rates. The study mentioned no prior research has analyzed cancer treatment and the racial disparities on a micro/individual level. The researchers used the data from the Surveillance, Epidemiology, and End Results (SEER)-National Longitudinal Mortality Study between 1973 and 2003 to carry out this study. The study examined 8 different common cancer tumors (breast, colorectal, prostate, lung and bronchus, cervix, ovarian, melanoma of the skin, and urinary bladder) diagnosed among men and women. People were categorized into non-Hispanic white, non-Hispanic black, Asian Pacific Islander, and American Indian/Alaskan Native. The study analyzed individual characteristics to determine possible disparities between racial and ethnic categories. The sociodemographics the researchers examined were education levels, income, poverty, socioeconomic status, and having health insurance. The researchers found that major racial disparities manifested themselves across socioeconomic levels. The researchers then controlled for socioeconomic levels, education, and income and found that blacks still had lower cancer treatments and survival outcomes compared to whites. After controlling for health insurance, however, the association of low survival and treatment among blacks compared to whites was no longer signicant. The researchers suggest this means coverage is a significant contributor to cancer survival and treatment. The researchers suggest that this study provides further information that improved quality access among racial and ethnic groups will help eliminate prevalent disparities in health care. (Du XL, Lin CC, Johnson NJ, and Altekruse S. (2011), Effects of individual-level socioeconomic factors on racial disparities in cancer treatment and survival. Cancer. 2011, 117(14): 3242–3251. doi: 10.1002/cncr.25854). 14. Racial Variation in Breast cancer Treatment Among Department of Defense Beneficiaries A recent study published in Cancer found that black women were less likely to receive chemotherapy with regional stage tumors, however, more likely to receive chemotherapy and hormonal therapy with local stage tumors. The article mentions that several studies have found significant disparities in breast cancer treatment between white and black women. This study, however, controlled for other possible variables that may contribute to such disparities. For example, age diagnosis, tumor stage, and hormone receptor status. The researchers analyzed data from 1998 to 2000 from the Department of Defense Central Cancer Registry and Military Health Care System. A total of 2,308 cases of women with breast cancer were eligible. Of that number, 85% were white (2303) and 14% was black (391). The researchers found that there was no significant difference in the type of surgery received by women after taking into account age and whether the patient was active duty or not. The variation in treatment depended on if the tumor stage was local or regional. The researchers found women with local stage cancer and hormone receptor-positive tumors, black women were more likely to receive treatment than white women. However, women with regional stage tumors, black women were less likely than white women to receive chemotherapy or hormonal therapy treatment. The researchers suggest that these findings provide a basis to understanding what other possible factors are important to consider when analyzing such racial and ethnic disparities in cancer treatment. For example, the age of the patient, tumor stage, and access to healthcare. Furthermore, the variations and differences in treatment among black and white women may be unknown, but the researchers suggest it may be multifactorial. (Enewold, L, Zhou, J, McGlynn, KA, et. al. Racial variation in breast cancer treatment among department of defense beneficiaries. Cancer. 2011; doi: 10.1002/cncr.26346). DISPARITIES DATA SPOTLIGHT
Near-poor and middle-income Medicare households (those between 100 percent and 399 percent of the poverty level) spend a greater share of their household budget on health care spending than either poor Medicare households or Medicare households above 400 percent of the federal poverty level. The proportion of Medicare household budgets spent on health also varies by age and whether an individual in the household qualifies for Medicaid. To learn more about health spending in Medicare households, please read, Health Care on a Budget: The financial burden of health spending by Medicare households |
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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. 
