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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. Laotian-Hmong Fare Worst in UCD Liver Cancer Study 8. At Hospitals, New Methods with a Focus on Diversity
10. Disease Rates Down Among Utah Hispanics 14. Connecticut Doc to Promote Aetna’s Care Equity DISPARITIES IN RESEARCH 17. Regional and Racial Variation in Primary Care and the Quality of Care among Medicare Beneficiaries DISPARITIES DATA SPOTLIGHT Distribution of Nonelderly Uninsured Below 133% of FPL by Race and Ethnicity, 2008 DISPARITIES IN THE NEWS 1. Laotian-Hmong Fare Worst in UCD Liver Cancer Study Analyzing data from the California Cancer Registry on more than 6,000 Asian American patients diagnosed with liver cancer between 1988 and 2007, the authors found that Laotian-Hmong Americans were more likely to be diagnosed at a later stage of cancer than other Asian ethnic groups. This delay decreases the survival rate of patients which further compounds disparities in overall health outcomes. Moon Chen, Jr, associate director of cancer control at the UC Davis Cancer Center, said that Laotian Americans have a liver cancer survival rate that is one to two times worse than the rate for all other Asian Americans. In addition, only three percent of Laotian-Hmong Americans with liver cancer had surgery or liver transplantation compared to the twenty two percent of other Asian Americans. “Liver cancer among Asian Americans is primarily related to infection with hepatitis B, which is endemic in many parts of Asia. The virus can pass from mother to unborn child, developing into cancer over many years” (Magagnini, 9/20). 2. City Signs on to Help Bridge Gaps to Healthier Neighborhoods The Boston Globe reports on a new $150,000 campaign from the Boston Public Health Commission which details differences in the health of Boston neighborhoods, “emphasizing that where you live matters to your health.” Spurred by research that has documented health disparities between Boston residents, and other research which has found that mortality is affected by one’s place of residence, the campaign aims to promote action by communities regarding their health through the message, “Where you live matters when it comes to health.” Campaign efforts include ZIP code billboards and a website, whatsyourhealthcode.com, that details the effect that living and working conditions have on health outcomes for individuals residing in 15 Boston neighborhoods. “‘I want somebody who’s impacted by this campaign to be the person who’s at a cocktail party or at a barbecue or around the watercooler who challenges the person next to them who says health is an individual thing,’” said Nashira Baril, codirector of the city’s Center for Health Equity and Social Justice. “‘I want the person touched by the campaign to say it’s much more than that.’” Addressing health disparities has been a priority for Boston for several years, with hospitals, city agencies, and the mayor all playing a role (Smith, 9/17). 3. Minnesota Kids Count Book Reveals Disparities Among Children of Color, American Indian Children A new data book by from the Children’s Defense Fund-Minnesota found that significant racial and ethnic health disparities between white and American Indian children and other children of color in the state persist, The Bemidji Pioneer (MN) reports. 4. MU Researchers Study Shortage of Rural Doctors With 2 in 10 people residing in a rural area and only 1 in 10 physicians practicing there – a disparity that is believed to be worsening – The Columbia Daily Tribune (Columbia, MO) reports on new research from the University of Missouri (MU) about why doctors choose to practice in rural communities. In a study described as an “awareness piece,” two MU researchers, Kathleen Quinn and Michael Hosokawa, interviewed 15 MU alumni who practice in rural areas. Quinn, director of MU’s Area Health Education Center said the hour-long interviews showed that “Where you’re from, where you train and who you marry are three major factors that determine where you practice.” Of the three doctors in the study who grew up in large cities yet practice rural medicine, Quinn said these individuals typically had either a positive personal or professional exposure to small town-life at some point in their lives. The authors suggest that medical schools may use their study during admissions processes to help identify students inclined to practice in rural areas, and that it may help them improve the Rural Track Pipeline Program, which places students in rural communities for medical training, and aims to keep them practicing there (Greaney, 9/11). 5. Helping Immigrants Learn to Talk Openly About AIDS The Seattle Times reports on the efforts of the Center for Multicultural Health in Seattle which recruits African immigrants to serve as peer-educators to help promote HIV/AIDS prevention. For some African immigrants who originate from counties with high rates of HIV/AIDS, it can be taboo to discuss HIV/AIDS prevention, or even their own diagnosis. In an effort to address this, the Center for Multicultural Health in Seattle recruits African immigrants to serve as peer educators to discuss HIV/AIDS with fellow African immigrants, and distribute HIV/AIDS-prevention information. Recruits include a local taxi driver who discusses prevention with and distributes materials to fellow drivers, and a coffee stand owner who caters to many East African clients and provides free condoms to passersby. The Center also pays individuals $20 to get tested; however, fear and stigma remain barriers to testing. “They want me to visit their house in the dark so people don’t get suspicious,” said Solomon Tsegaselassie, who was a health worker in his native Ethiopia, and is currently a health educator at the Center. Local health providers say that engaging African immigrant women is a particular challenge, as they have traditionally faced the brunt of HIV/AIDS stigma, and may forgo testing or seeking proper treatment or social support as a result. According to the Washington Department of Health, among foreign-born black immigrants in the state, women accounted for 50% of all HIV cases (Anderson, 9/8). 6. Make Good on Federal Promise for Native Health Care In an opinion piece in The Seattle Times, guest columnist, Ralph Forquera, director of the Seattle Indian Health Board, urges Congress to adopt the 8.7% increase in Indian Health Service (IHS) appropriations proposed by President Obama to fulfill the “moral and legal obligation to provide health services to Indian people.” Forquera notes that while the health care legislation signed into law earlier this year includes permanent reauthorization of the Indian Health Care Improvement Act “which provides the basic structure for the IHS,” Congress did not include funding for the Act in the legislation. Noting the history of the government’s role in ensuring the health of Indian people, he writes that that the government has “fallen far short” of fulfilling its obligations. He notes that the IHS – the agency that provides health care to federally recognized tribes in the U.S – is “severely and chronically underfunded,” despite the “serious health problems affecting Native people.” As an example, Forquera also notes that in 2005, the federal government spent $2,130 for IHS beneficiaries compared to $5,010 and $7,631 for Medicaid and Medicare beneficiaries, respectively. He continues that urban Indians, who represent 67% of Native people, receive only about 1% of IHS funding. Despite these funding challenges, Forquera writes that “the IHS system operates many excellent facilities and supports innovative health organizations,” but notes that many Natives people often go without needed care, and states that the IHS system could do “much more” with adequate funding. “When President Obama signed major health reform in March, many heralded it as a historic act. Indian people are part of this history, too, but how it will turn out for us depends on congressional action in coming months,” Forquera writes. (Forquera, 9/8). 7. N.J. Health Campaign Focuses on Minorities The New Jersey Office of Minority and Multicultural Health will be launching over 175 health events this month to promote health awareness among minority communities and assist those who have difficulty accessing care, the Courier-Post (Cherry Hill, New Jersey) reports. This month, New Jersey is launching the “Health Me, Healthy Us” campaign targeting racial and ethnic communities, and will provide educational information on proper diet and exercise, screenings for chronic conditions such as diabetes and hypertension, and medical advice from volunteering health care providers. As communities of color disproportionately suffer from a number of chronic yet preventable illnesses, the campaign will also promote the importance regular doctor visits and following doctors’ advice. Among the events that will be held as part of the campaign will be a Minority Health and Wellness Day, which will provide screenings for diseases including hypertension and HIV, and information about area health care. In addition, the New Jersey State Conference of the NAACP will host a health fair during its annual conference. These events will also serve as an important source of access to care for many state residents who either lack access to care, or who have difficulty accessing it. Kristin Nicely Colangelo, program director for the Office of Minority and Multicultural Health’s health education and family prevention unit explains, “Many people in the city either have not had health care, or they are losing health care with New Jersey Family Care and other state program cuts. Families are needing assistance with health issues.” Rosalind Seawright, who leads the New Jersey NAACP’s health committee, said “health disparities impact people of color at a disproportionate rate. Providing information about health disparities and information about agencies that can help is one way of addressing this issue” (Shamlin, 9/7). 8. At Hospitals, New Methods with a Focus on Diversity “As more immigrants crowd its waiting rooms, Elmhurst Hospital is joining a growing number of hospitals in New York and across the country that are going beyond hiring interpreters and offering translated paperwork and are adopting practices intended to improve care for an increasingly diverse patient population,” The New York Times reports. Practitioners across the nation – from states like California and New York that have large immigrant populations, to other places, like Storm City, Iowa, which have attracted diverse populations due to industry – are surveying their patients, traveling abroad, and instituting programs and practices gain knowledge of the views of their patients which may influence their health. “One thing you don’t learn in medical school is how to interpret cultural cues, but they’re key when you’re dealing with a diverse population,” said Dr. Braden Hexom, an emergency room doctor at the Elmhurst Hospital Center in Queens, “a borough that is home to 2.3 million people from more than 100 countries.” Among the efforts at Elmhurst Hospital is a diet plan in the hospital’s diabetes nutrition classes that incorporates foods like guava paste and plantains to cater participants from Latin America, and a survey of new mothers conducted by lactation consultants to better understand the diverse views about breast feeding. Similarly, after receiving complaints about the hospital from Mexican and Central American immigrants, the chief executive of the Buena Vista Regional Medical Center in Storm Lake, “a city of 12,000 that has been transformed by an influx of Hispanics who work in the area’s meatpacking plants,” took a group of practitioners to Mexico in 2004 to learn about the health care system in the country. The medical center has since instituted a training program that addresses views on issues like birth and illness among people from Mexico and Central American. In explaining these efforts, Dr. Jasmin Moshirpur, regional director of the Queens Health Network, which includes Elmhurst Hospital, said “A good part of the mentality is still to provide what our patients needs. Health needs come first, of course, but there’s no question we can be better doctors if we’re also mindful of patients’ cultural needs” (Santos, 9/6). 9. Deal Would Provide Dialysis to Illegal Immigrants in Atlanta The New York Times reports on a tentative agreement reached between local commercial dialysis providers and Grady Memorial Hospital in Atlanta to provide dialysis for 38 end-stage renal disease patients (ESRD), most of them illegal immigrants. “Illegal immigrants, and legal immigrants newly in the country, are not eligible for Medicare, the federal program that covers most dialysis costs for American citizens with end-stage renal disease.” The issue also “remains unaddressed by the new health care law, which maintains the federal ban on government health insurance for illegal immigrants.” If the deal is completed, Fresenius Medical Services and DaVita, Inc. – the nation’s largest commercial dialysis providers – and Emory University’s health system, would each provide care for about 3-5 immigrants as charity cases, with the others being treated by Fresenius with financial help from Grady. The new agreement comes after Grady closed its outpatient dialysis clinic last year, which displaced about 60 uninsured illegal immigrants. “Patients with end-stage renal disease can die in as little as two weeks without dialysis, which filters toxins from their blood.” Grady volunteered to both transport these patients to other states or to their countries of origin and pay for 3 months of treatment. Thirteen patients accepted. However, after media scrutiny and a patient lawsuit, the hospital contracted with Fresenius to treat the other immigrants in Atlanta for one year. This contract ended the same day the tentative new deal was brokered. Grady, which is the safety-net hospital in Atlanta, and receives direct appropriations from 2 Atlanta counties, has spent over $2 million on repatriation and dialysis since the clinic closed last fall. It is still uncertain exactly how the patients will be distributed between the commercial providers and the health system, how much financial help Grady will provide, and how long this agreement will last. In addition, “the agreement would not address the broader concern of how to care for illegal immigrants in the region who have developed renal disease since the Grady clinic’s closing, or those who will do so in the future” (Sack and Einhorn, 8/31). 10. Disease Rates Down Among Utah Hispanics According to a new report from the Utah Department of Health’s Center for Multicultural Health, from 2005-2010, Hispanics in Utah showed improvements in about 90% of the key disease indicators examined, Deseret News (Salt Lake City, UT) reports. Among the disease rates that fell for Hispanics from 2005-2010 were colon, lung, breast, and prostate cancer, the death rate due to diabetes, and the death rate due to stroke. While Hispanics also saw declines in rates of gonorrhea and tuberculosis, the rates were still higher than the rate for the overall Utah population. In addition, current rates of arthritis, coronary heart disease death, breast and prostate cancer among the Hispanic population in Utah were lower than statewide rates. Chlamydia, which has increased for all racial and ethnic groups examined in the report, was the only disease in that did not improve among Utah Hispanics during this time The report examined other health and health care indicators among Hispanics in Utah, as well as among other racial and ethnic groups in the state (Lee, 8/31). 11. Patrick Says Health Care for Immigrants May Not Come to End As upwards of 23,000 legal immigrant Massachusetts residents who have lived in the U.S. for less than 5 years will lose their health insurance by the end of December without action, Massachusetts Governor, Deval Patrick said he hopes to use some federal Medicaid money to help continue their coverage, The Boston Globe reports. “Immigrant and consumer advocates are urging lawmakers to fund a limited program for these immigrants using a portion of an estimated $450 million in federal aid recently sent to Massachusetts to help pay for Medicaid programs.” While the governor and lawmakers have yet to decide how the funds will be used, Governor Patrick said he’s looking to try to use some of the funds to help this population retain their health coverage. “These are taxpayers. They contribute to our society through their work and through their taxes, and I think that we get good value out of this program,’’ he said. Currently, states that provide health care to legal immigrants who have lived in the country for less than five years – or “aliens with special status” – do not get reimbursed for that care by the federal government. However, under the health reform law passed earlier this year, states that provide care for “aliens with special status” will begin to reimbursed by the federal government in 2014 (Cheney, 8/27). 12. National Health Initiative is Hitting S. Florida Barbershops The Black Barbershop Health Outreach Program, which aims to increase awareness about health and the importance of health screenings among African Americans, is coming to 16 South Florida barbershops and beauty salons for the first time, the Sun Sentinel reports. Launched by the Diabetic Amputation Prevention Foundation in 2007, the goal of the program is to provide education and health screenings to African Americans by partnering with black-owned barbershops and salons, other facilities, organizations, and local leaders. In addition to providing free on-site health screenings for diabetes and blood pressure, the program also provides educational materials and a medical resource guide. Many of the illnesses that disproportionately African Americans are preventable with regular doctor visits, however African Americans, and specifically black men, do not have regular check-ups. “The black barbershop is an institution in the African-American community, providing a trusted and familiar place for many black men to receive health information and services that they would otherwise not have access to,” said Rep. Alcee Hastings (D-FL), who sponsored a resolution supporting the Outreach Program last month. Since its inception, the program has screened about 15,000 people in 230 black-owned barbershops and salons nationwide, and aims to screen 20,000 people this year (Lewis, 8/26). 13. A Youthful Remedy; Two Dozen Young People Bring a Dose of Verve to the August College of Physicians in a Program Meant to Multiply Minorities in the Health Sciences The Philadelphia Inquirer Daily Magazine reports on the Junior Fellows program at the College of Physicians, a three-year program aimed at correcting racial and ethnic disparities in the health professions, and preparing students of color for careers in the health field. Started in August 2009 by the College of Physicians – the oldest medical society in the country – the Junior Fellows program exposes students from underrepresented communities to career opportunities in the health field. As research has found that the “underrepresentation of racial and ethnic minorities in the health-care professions resulted in a diminished standard of care for minority patients,” College CEO, George Wohlreich, insisted that the institution take an active role in correcting these disparities. He “says the college is using all its resources – its research arm, library, museum, and 1,400 fellows – to expose junior fellows to the heritage and ideals of medical science.” Through the program, the Fellows are matched with mentors in their field of interest, undertake internships, and receive hands-on curriculum, like the ability to create a museum exhibit. The first-ever group of Junior Fellows is currently halfway through the three year program, and will continue through August 2012 (Marder, 8/24). 14. CT Doc to Promote Aetna’s Care Equity Aetna, Inc. named physician, Wayne Rawlins, to be Aetna’s first national medical director of racial and ethnic quality initiatives, Hartford Business Journal reports. In this new position at Aetna, Rawlins will “identify disparities in care among Aetna’s minority members and…spearhead programs that promote more equitable health care.” Aetna’s chief medical officer, Lonny Reisman said, “Having a senior level clinician devoted entirely to this effort will help us take many of our programs further as well as gain new insights from research that can lead to better health outcomes for minority populations.” Aetna is attempting to identify and address racial and ethnic disparities in care among its members, with data on more than 6 million active members (8/11). DISPARITIES IN RESEARCH 15. African American’s Awareness of Disparities in Infant Mortality Rates and Sudden Infant Death Syndrome Risks In a new Journal of Health Care for the Poor and Underserved study, the authors found that African Americans with less social capital, education, and awareness of Sudden Infant Death Syndrome (SIDS) experienced higher infant mortality rates. The authors conducted a telephone survey of 804 African Americans living in four San Francisco neighborhoods with the highest number of African American births. They found that 57.3% of African Americans were unaware that African American babies in San Francisco were two to three times more likely to die than white babies. Those who knew about the mortality disparity were more likely to be over 40 years old (44.6% vs. 27.2%) and have more than a high school education (43.5% vs. 33.7%). The authors also noted that participants who knew about disparities were 1.5 times more likely to have volunteered in the community; participants who were aware of the importance of putting infants to sleep on their backs were more likely to have at least a high school education (odds ratio [OR]: 1.4); and have a sense of belonging in the African American community (OR: 1.6). Those with lower levels of awareness about the proper infant sleep position experienced less community cohesiveness and were more likely to report experiencing barriers to community involvement. The authors note the significant role that local organizations play to raise awareness in the community, stating that campaign efforts to reduce infant mortality should be more culturally relevant and emphasize community dialogue in efforts to decrease disparities. 16. Availability and Accuracy of Medical Record Information on Language Usage of Cancer Patients from a Multi-Ethnic Population In a new Journal of Immigrant and Minority Health study, the authors found that although documentation of language use among cancer patients in medical settings was widely available, data is not always collected uniformly and accurately. Reviewing the medical records of 2,247 cancer cases from 37 hospitals identified from the Greater Bay Area Cancer Registry (GBACR), the authors found that language information was available in about 86.4% of the medical records of patients for whom language information had previously been collected in research studies, and in 81.6% of the medical records at the 27 facilities in which information could not be extracted electronically. Language information availability was greater for non-white patients compared to non-Hispanic white patients, and also for those diagnosed at larger facilities or in private or non-teaching hospitals compared to those diagnosed at smaller facilities or at teaching hospitals. In examining the accuracy of language documentation in medical records, the researchers found that overall agreement between medical-record based reporting and interview language was 79.3 percent. Agreement was greater for females, patients who were diagnosed at younger ages, non-Hispanic white and black patients compared to Hispanics and non-Hispanics Asians and Pacific Islanders, patients born in the U.S., and those who were diagnosed at private and teaching hospitals, and at hospitals in which informational was extracted electronically. In the discussion, the authors note that although documentation of language usage is largely available in the Greater San Francisco Bay Area, collection of information is not always accurate, consistent, or complete. They suggest the need for state or federal policies to enforce accurate data collection to further understand health disparities brought about by language barriers. 17. Regional and Racial Variation in Primary Care and the Quality of Care among Medicare Beneficiaries In a study conducted by The Dartmouth Institute for Health Policy and Clinical Practice, the authors found racial and other differences in primary care, quality of care, and health outcomes of Medicare beneficiaries. Medicare fee-for-service beneficiaries eligible for Part A and B from 3,436 Hospital Service Areas (HAS) and 306 Hospital Referral Regions (HRR) were sampled to examine the relationship between the number of primary care physicians and quality of care within and across regions. The authors found that, compared to white beneficiaries, African Americans were 84% more likely to be hospitalized. They also found that African American beneficiaries were less likely than white patients to see a primary care physician, and among diabetic patients, African Americans were 4.7 times more likely than whites to have an amputation. These findings were not consistent across all regions, such as Waterloo, Iowa, where African Americans were more likely to visit a primary care physician than whites. The authors also found that an increased supply of primary care physicians did not correlate to enhanced annual visits by Medicare beneficiaries, but did increase the likelihood that female beneficiaries obtain mammogram exams and diabetics receive a hemoglobin A1c test. While noting that access to care does not insure high-quality care, the authors also found no correlation between the number of office visits and delivery of annual eye or blood lipid tests for diabetics, a measure of high-quality care. In addition, the researchers found no correlation between primary care visits and health outcome (as measured by rate of amputation). When comparing breast cancer screening, leg amputation, hemoglobin A1c test, and hospitalization rates between African American and White beneficiaries, they found that, overall, African Americans had a lower rate of breast cancer screening and hemoglobin A1c tests, and a higher rate of leg amputations and hospitalizations compared to white beneficiaries, though some regional variation existed. The authors concluded that increased access to primary care physicians may not be sufficient to overcome racial health disparities in quality and outcome, and that more focus needs to be concentrated on the coordination of care among providers and improvement of health care services. 18. Relationship Between Patient Panel Characteristics and Primary Care Physician Clinical Performance Rankings “[P]atients panels with greater proportions of underinsured, minority, and non-English-speaking patients were associated with lower quality rankings for primary care physicians,” wrote the authors of a new study published in the Journal of the American Medical Association. Using data from 162 primary care physicians treating 125,303 adult primary care patients to create a composite physician quality score, the authors found that primary care physicians in the top tertile of measured quality were more likely than those in the bottom tertile to care for patients who were older (51.5 years vs. 46.6 years); made more frequent primary care visits (71.0% vs. 61.8% with more than 3 visits per year); had a higher number of comorbidities (0.91 vs. 0.08); and were less often female (34.2% vs. 47.5%). Additionally, compared to those in the bottom tertile, primary care physicians in the top tertile had fewer minority patients (13.7% vs. 25.6%); non-English-speaking patients (3.2% vs. 10.2%); and patients with Medicaid or who were uninsured (9.6% vs. 17.2%). Patients of top tertile physicians compared to bottom tertile lived in neighborhoods with higher median household incomes ($63,901 vs. $53,890) and higher high school graduation rates (87.9% vs. 82.7%). After the authors adjusted for patient panel characteristics, there was a substantial jump in the relative quality rankings for most primary care physicians. The authors conclude that the results of their study “provide evidence of the effect of patient panel makeup on attainment of HEDIS quality measures.” They note that “to the extent that health systems reward physicians for higher measured quality of care, lack of adjustment for patient panel characteristics may penalize physicians for taking care of more vulnerable populations, but also remark that “adjustment for patient panel characteristics may remove the incentive to improve care or may inappropriately reward lower-quality physicians caring for more vulnerable patients.”
NOTE: In 2009, the federal poverty level was $18,310 for a family of three. The Patient Protection and Affordable Care Act increases Medicaid eligibility to 133% of the federal poverty level (FPL), which has the potential to significantly reduce the number of uninsured. There are over 22 million nonelderly uninsured individuals in the U.S. with incomes below 133% of FPL (currently $14,404 for an individual and $29,327 for a family of four), and nearly 6 in 10 are people of color. The Congressional Budget Office estimates that raising the eligibility level to 133% would lead to 16 million new enrollees in Medicaid and the Children’s Health Insurance Program, many of them likely people of color. For more information about how health reform might affect communities of color, please see the updated issue brief, Health Reform and Communities of Color: Implications for Racial and Ethnic Health Disparities. |
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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. 
