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. D.C., Suburbs Show Disturbing Increase in Childhood Poverty

The Washington Post reported on new Census data indicating that the number of D.C. children living in poverty continues to increase, and at 43%, black children represented the group with the highest percentage of children in poverty.

"Three out of 10 children in the nation's capital were living in poverty last year." The poverty rate for Hispanic children increased 2 percentage points to 13 percent and for white children one percentage point to 3 percent. The recent Census indicates that black children living in poverty has increased from 36 percent in 2008 to 43 percent in 2009. The increase in the poverty rate correlates with the high unemployment rate found throughout the city, but even working families are having financial difficulties. Jenny Reed, an analyst the D.C. Fiscal Policy Institute, said "a lot of families in D.C. are in low-wage jobs, so even though they're working, they're not earning enough to live above poverty." The District's poverty rates have increased as to surpass the rates of Mississippi, which holds the nation's lowest median income. Even more affluent states like Maryland, which holds the nation's highest median household income, experienced a doubling in childhood poverty. "People say Maryland is immune, but this shows you it isn't," said Matthew Joseph, executive director for Advocates for Children and Youth in Baltimore. Childhood poverty also increased in several Virginia counties, like Fairfax, where one in five black children is living in poverty.

Although childhood poverty levels increased, the Census showed that the number of insured children nationally increased from a 90.3 percent in 2008 to 91 percent in 2009 (Morello and Keating, 9/29).

TOP

2. Chicago Churches Screen Parishioners for HIV; More Than Two Dozen Predominantly Black Churches Participate

Approximately 40 members from over two dozen predominantly black churches participated in a recent HIV screening event, the Chicago Tribune reported.

Similarly to the national data, African Americans in the Chicago area are disproportionately affected by AIDS and HIV. According to the AIDS Foundation of Chicago, African Americans represent about 37 percent of the city's population and account for 56 percent of people living with HIV. Today, many black churches have become advocates for awareness and education about HIV and AIDS. This HIV screening idea sprung from a discussion last summer among about 100 Chicago-area wives of pastors and female pastors about how to increase HIV testing among the community. "We wanted to increase the awareness in other communities and in other churches," said Jamell Meeks, who directed the HIV screening campaign. The director of the Illinois Department of Public Health, Damon Arnold, encouraged more congregations to continue to get tested and seek treatment.

In addition to HIV testing, the event also held blood pressure and diabetes screenings (Schorsch, 9/30).

TOP

3. Chicago Women Lag in Breast Cancer Screening

The Chicago Sun-Times reported on a Dartmouth Atlas Project that found that female Medicare recipients in the Chicago area have the lowest mammography screening rates in the nation, and also documented racial disparities in screening rates in the city.

The Dartmouth study found that between 2003 and 2007 63.2% of female Medicare beneficiaries between the ages of 67 and 69 had at least one mammogram in the past two years, compared to only 50.1% in Chicago. This is lower than the rates found in New York (51.4%) and Los Angeles (52.4%). The study also documented racial disparities in screening rates, with 53.1% of white Medicare recipients receiving a mammogram during the same period compared to 46.1% of blacks. Some experts question whether the low screening rates—which have been documented among other females population groups in Chicago—factor into the racial disparities in breast cancer mortality observed in the city. For example, a 2009 study from the journal, Cancer Causes and Control, found that only 254,000 mammograms were provided to the 588,000 women in Chicago for whom mammograms were recommended, and a 2008 study from the Sinai Urban Health Institute found that black women in Chicago were more than twice as likely as white women to die of breast cancer. The Cancer Causes and Control study also found racial differences in the quality of mammography care received, with black women in Chicago less likely to be screened at accredited centers or be read by a radiologist trained in mammography.

According to Dr. Linda Rae Murray of the Chicago Breast Cancer Quality Consortium—"a coalition of mammography centers throughout the Chicago area"—the Consortium has been working on several initiatives since 2008 to increase access to mammograms and treatment (Thomas, 9/28).

TOP

4. Black and White Patients May Not Receive the Same End of Life Care, Study Finds

In a new study from the Archives of Internal Medicine, that was reported on in the Los Angeles Times, the authors found end of life (EOL) care disparities between black and white patients who communicated with their physicians, with white patients receiving more symptom-directed care over life-prolonging EOL care than black patients.

The study which included 71 black patients and 26 white patients with advanced cancer sought to determine if patient-physician communication contributes to in end of life care disparities between black and white patients. Although a similar percentage of black (35%) and white patients (38%) had end of life discussions with their physicians, researchers found that black patients were less aware of their terminal illness compared to white patients. Among black patients, differences in the level of education also played a role in end of life care discussions. Black patients with more years of education were more likely to have end of life discussions with their provider than black patients with fewer years of education. Additionally, end of life care discussions were correlated with increased utilization of hospice care. The researchers also found that EOL instructions for black patients were not always followed. For example, among black patients with do-not-resuscitate (DNR) instructions, the likelihood of them receiving end of life treatments was the same as black patients without DNR instructions.

The authors concluded that "more work is needed to identify ways to help black patients receive the same benefits of such [end of life] discussion as white patients" (Stein, 9/28).

TOP

5. IHS to Use Satellite Phones to Communicate In Rural Locations

The Daily Times (Farmington, NM) reported on a new pilot study launched by the Indian Health Service (IHS) and broadband company, LightSquared, to increase communication between health care providers and American Indian communities.

LightSquared is aiming to help bridge the communication gap between rural health providers in New Mexico, Arizona, and Texas with the Indian Health Service by providing 2,000 satellite phones to IHS. The telecommunication pilot program will be based in Albuquerque, New Mexico and phone series will be free-of-charge through 2020. The program is expected to save as much as $10,000, the cost of providing phone lines to existing homes. "Light Squared services will help in the continued efforts to bridge the digital divide," said New Mexico Senator, Tom Udall. Eleven health centers, twelve field clinics, and four hospitals will benefit from the telecommunication service.

"Our goal is to deliver the benefits of modern communications to people who have little or no access and bolster their ability to provide potentially lifesaving services to their fellow citizens," said Sanjiv Ahuja, CEO of LightSquared (Landry, 9/29).

TOP

6. Groups Study Disparity Remedy

The Winston-Salem Journal (Lexington, NC) reported on a collective effort from 20 educational, health, and philanthropic groups and institutions which participated in the State of Minority Health and Health Disparities in N.C. conference at Senior Services Inc. working to improve minority health.

According to the America's Health Rankings reported, North Carolina ranks 37^th in overall health, and has ranked similarly for most of the past 2 decades. According to Dr. Jeffrey Engel, North Carolina's health director, the state's low ranking is attributed to the health of its minority population. At the conference leaders from different health professions joined together to understand the complexities facing minority populations to further advance the health of the state. "Minorities represent a growing part of the state's population … It is critical that we close the gap in minority health outcomes if we expect to reach our goals for a healthier North Carolina," said Dr. Engel. State officials agreed that more local efforts are needed to improve the health of low-income communities, including the addition of sidewalks, and encouraging health through diet and exercise.

Some of the groups and institutions represented at the conference included Duke's Global Health Institute, East Carolina, Fayetteville State, UNC Chapel Hill, Wake Forest and Winston-Salem State (Craver, 9/25).

TOP

7. Black Veterans Face Harsher Health Care Issues

The New York Amsterdam News reported on some of the challenges veterans face when returning from combat, and in particular, some of the unique health issues black veterans face.

With thousands of troops returning from combat missions, one of the challenges they will encounter back home is access to health care services. Many veterans coming back will require access to mental health and suicide prevention services. In addition to such post-war needs, black veterans face unique challenges. "The incidence of diabetes and hypertension that come with high stress are higher in Black veterans," said Gen. Robert Cocroft, national commander of the National Association for Black Veterans. Furthermore, "where minorities receive their care may contribute to disparities in care" noted a study done by the Harvard School of Public Health and the Center for Health Equity Research and Promotion. The authors of the study found that 42 out of 150 VA hospitals cared the health needs of 75 percent of black veterans, suggesting that black veterans receive assistance from few VA hospitals compared to their white counterparts.

"Black veterans face unique types of situations … and that is being able to get assistance with the claims process that is culturally sensitive to Black veterans," said Gen. Robert Cocroft, the national commander of the National Association for Black Veterans (Paye, 9/22).

TOP

8. Local Lesbians Concerned About Breast Cancer Risk

The Desert Sun (Palm Springs, CA) reported that lesbian and bisexual women may be at greater risk for developing breast cancer, but that more research is needed.

According to the American Cancer Society, breast cancer risk factors include being overweight, a smoker, and having irregular doctor visits, characteristics that are more often observed in the lesbian and bisexual than heterosexual community. "When people think of health disparities, they think of race and ethnicity, but they don't always think about sexual minorities," said Paula Amato, M.D., an associate professor at Oregon Health & Science University in Portland. Dr. Amato also notes that while current data indicating differences in breast cancer prevalence between lesbians and heterosexual women is conflicting, the community does have a higher prevalence of certain risk factors. To address concerns in the lesbian and bisexual community, local leaders formed the Desert Women for Equality which has sponsored more than 2,600 free mammograms. "I think it's all about self care as a woman, whether you're a heterosexual or a lesbian. You have got to pay attention to your body," said Diana Mehrens, a local cancer survivor.

The Desert Women for Equality has been active in the community since 2006 (Brambila, 10/10).

TOP

9. U.S. Hispanics Outliving Whites, Blacks

New data released by the National Center for Health Statistics showed that in the U.S., Hispanics have a longer life expectancy than whites and blacks, according to an article in USA Today.

These data provide evidence of the "Hispanic mortality paradox." According to Elizabeth Arias, author of the report, "you would expect the Hispanic population would have higher mortality" as "mortality is very correlated with income, education and health care access." Yet, despite having a low socioeconomic status compared to non-Hispanic whites, Hispanics have a higher life expectancy at birth and at almost every age. The paradox has been known for more than two decades and this is the first time enough data is available to reflect national numbers. The new data shows Hispanics outliving whites by 2.5 years and blacks by 7.7 years, on average. Potential factors contributing to longevity include Hispanic culture, lifestyle, and migration. Hal Strencik of the Montefiore Medical Center in New York City states that "people who are socially connected do better than people who are isolated." Along with a social network, Latinos may exhibit the "health migrant effect" which states that healthy people are more likely to emigrate.

The National Institutes of Health is further launching a study to report mortality differences among Hispanic subgroups (El Nasser, 10/14).

TOP

10. Kids' Medicaid-Covered Flu Shots Put Docs at a Loss: Study

Business Week reported that increasing the Medicaid reimbursement rate would increase the number of low-income children vaccinated, and reduce costs associated with treating the flu.

Recent findings from a study conducted at the University of Rochester Medical Center (URMC) found a correlation between Medicaid reimbursement rate and flu immunization rates among states throughout the US. According to Dr. Byung-Kwang Yoo, assistant professor at URMC in the Department of Community and Preventive Medicine, "physicians lose money every time they give a flu shot, even though vaccines are provided for free." Although prior research estimated the cost to a doctor for administering the flu shot to be about $20, the average Medicaid reimbursement is half that at $9, and reimbursement rates range from as low as $2 in Colorado to as high as $18 in New York. Yoo and colleagues calculated that increasing the Medicaid reimbursement rate by one dollar could increase vaccination rates in low income children by as much as 0.9 percent, and reduce treatment costs. The authors noted the cost of flu-related hospitalizations for young children, those less than 5 years, is as much as $163 million annually, with as much as $279 million more spent on emergency room visits.

"The more children with access to seasonal flu vaccinations, the lower the overall burden will be on our health care system from the costs associated with treating influenza," said Dr. Peter Szilagyi, co-author of the study published in the journal of Pediatrics (Preidt, 10/18).

TOP

11. Research Aims to Cut Disparities in Stroke Care

African Americans and Hispanics are more likely to have a stroke than non-Hispanic whites but less likely to receive timely treatment, the AP/The Capital reported.

Stroke is the leading cause of disability and the number 3 cause of death in the U.S., affecting nearly 795,000 Americans annually. Although strokes manifest themselves through temporary physical impairments, too many Americans either ignore symptoms or do not arrive at the hospital in time for TPA, the main clot-dissolving drug. TPA has been shown to reduce permanent disability resulting from ischemic stroke when given within three hours after the onset of symptoms, and while treatment has been available for the past 14 years, only 5 percent of stroke patients ever receive it on time. Research indicates that racial and ethnic minorities are more likely to have strokes at an earlier age underscoring the importance of increasing outreach and education. Georgetown University launched a project funded by the National Institutes of Health which targeted a senior center in a predominantly black neighborhood in Washington D.C. This project began in part as a response to recent university findings that demonstrated that black patients received TPA less often than whites due to slower hospital arrivals. Similar reports indicated that Mexican Americans were 40 percent less likely than whites to call 911 for a stroke.

Washington D.C. currently has three certified hospitals with 24-hour TPA services (Neergaard, 10/12).

TOP

DISPARITIES IN RESEARCH

12. Recommendations for Intrauterine Contraception: A Randomized Trial of the Effects of Patients’ Race/Ethnicity and Socioeconomic Status

A new study published by the American Journal of Obstetrics and Gynecology found that a woman's race and ethnicity and socioeconomic status (SES) influences whether a health care provider will recommend intrauterine contraception (IUC).

In the study, 524 healthcare providers watched one of 18 videos produced by the authors that depicted white, black and Latina patients with either low or high socioeconomic statuses. Each woman had a similar health profile. Physicians were then asked if they would recommend IUC to the patient using a survey about contraceptive recommendations for the patient shown. The authors found that low SES women were significantly less like to have IUC recommended compared with high SES women (57% vs. 75%). The study also found that providers were more likely to recommend IUC to black women (75%) than white women (57%), but no differences were observed in the recommendations between white and Latina women. Recommendation differences also existed between low and high SES within black and white patients. Low SES black (41.9%) and white patients (63%) were less likely to have an IUC recommendation than high SES black (74.1%) and white (86.2%) patients. No significant differences were found among low and high SES Latina patients (66.7% vs. 65.5%). However, the authors did find recommendation discrepancies among racial and ethnic groups of low socioeconomic status. Low SES black and Latina patients were more likely to have IUC recommendation than low SES white women. The authors found no recommendation differences among high SES women by patient race/ethnicity.

The authors said their findings "suggest that providers of contraception, policy makers, and advocates should be aware of the potential effect of patient sociodemographic characteristics on contraceptive recommendations," and that future research "should build on research in other fields that suggest that enhancing provider awareness of the presence and effect of stereotyping and promoting an emphasis on patient-centered care may be of use in decreasing health care disparities."

(Dehlendorf C, Ruskin R, Grumbach K, et al. "Recommendations for Intrauterine Contraception: a Randomized Trial of the Effects of Patients' Race/Ethnicity and Socioeconomic Status." American Journal of Obstetrics and Gynecology, 203, no. 4. (October 2010): 319.e1-319.e8.)

TOP

13. Race, Ethnicity, and Shared Decision Making for Hyperlipidemia and Hypertension Treatment: The DECISIONS Survey

In a new study published by the journal of Medical Decision Making, researchers found that racial and ethnic minorities were less informed about and less involved in the final decision-making process for hyperlipidemia treatment than non-Hispanic whites.

Using data from the National Survey of Medical Decision Making Study, 1483 black, white and Hispanic respondents with either one of two medical conditions, hypertension or hyperlipidemia were studied regarding the patient-physician medical decision making process. Eligible respondents were either taking medication or discussed starting or discontinuing medication with their health care provider within the previous two years and were asked questions regarding their experiences and attitudes about the decision-making process for medication therapy. Respondents were 88% white, 9% black, and 4% Hispanic and 50% were in the high-blood-pressure module and 50% were in the high cholesterol module. The authors found differences in decision making were present in patients with hyperlipidemia. Black and Hispanic respondents were less likely to know information regarding high cholesterol therapy than whites when asked questions (41.3% vs. 51.8%). When asked about normal cholesterol levels, minority patients were less likely to choose the correct value range than whites (32.7% vs. 61.8%). Furthermore, 31.7% of minority respondents were more likely to say the final decision for hyperlipidemia treatment was made by the provider compared to 12.3% of whites. For the hypertension module, the authors did not find a significant difference between whites and blacks and Hispanics regarding hypertension therapy knowledge. Minority patients were less likely to select the correct blood pressure values than whites, 86.6% and 75.7% respectively. In contrast, the authors found minority respondents were more likely to know the duration of hypertension therapy than whites 86.6% and 75.7% respectively. Compared to the decision-making observed in minority patients with high cholesterol, there were no differences observed in the decision-making by minority patients with high blood pressure.

The authors noted the importance of shared decision making in promoting patient adherence to medical management of cardiovascular risk factors largely observed in ethnic and racial minorities.

(Ratanawongsa N, Zikmund-Fisher B, Couper M, et al. "Race, Ethnicity, and Shared Decision Making for Hyperlipidemia and Hypertension Treatment: The DECISIONS Survey." Medical Decision Making, 30, no.5. (Sept-Oct 2010): 65s-76s.)

TOP

14. Housing Environments and Child Health Conditions among Recent Mexican Immigrant Families: A Population-Based Study

In a new study by the Journal of Immigrant and Minority Health, researchers found that children of immigrant parents are more likely to be exposed to environmental risk factor leading to asthma and atopy- an allergic hypersensitivity reaction.

The authors used community health workers to conduct 250 household surveys of recently immigrated Mexican families including 574 children. Households consisted of at least one foreign born parent, used Spanish as the primary language, and had at least one child. Data collection was done between November 2005 and August 2007, during which time community health workers conducted Spanish surveys and obtained blood lead samples, while inspectors analyzed household conditions and took environmental samples. The authors found that over 35% of homes were overcrowded and 54% of households had incomes of less than $20,000 a year. Adequate ventilation was found in only 28% of homes while mold and pests were found in 44% and 28% of homes respectively. When the authors performed an exploratory analysis to find the relationship between housing conditions and symptoms of asthma and atopy, they found that the prevalence of wheezing symptoms increased with decreased ventilation. Atopy symptoms were noted in 15.5% of children living in homes with minimal to no ventilation. Household pests also contributed to children's health as wheezing symptoms were more evident (8.1%) among children living in households with pests than children living in households without pests (2.3%).

The authors noted that children of recent immigrants may be less likely to access medical care and go undiagnosed. Authors suggested that solutions include household-level improvements and access to health care by partnering with public health organizations and clinics to raise awareness of housing and child health needs.

(Litt JS, and Goss C. "Housing Environments and Child Health Conditions among Recent Mexican Immigrant Families: A Population-Based Study." Journal of Immigrant and Minority Health, 12. (2010): 617-625.)

TOP

DISPARITIES DATA SPOTLIGHT

NOTE: Includes beneficiaries who were in long-term care facilities as of January 1, 2006, including those who died before the end of 2006. Excludes Medicare Advantage enrollees. Excludes Medicare prescription drug spending.

SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey Cost & Use Files, 2006.

Of the Medicare beneficiaries living in long-term care facilities, 1 in 6 is a person of color. Beneficiaries living in long-term care facilities have high rates of emergency room visits, hospital visits, and stays in skilled nursing facilities, and some of these visits are potentially avoidable. Researchers estimate that if hospitalizations in the long-term care population could be reduced by 25%, Medicare could save at least $2.1 billion in 2010 alone.

For more information on Medicare spending and the use of medical services among beneficiaries living in nursing homes and other long-term care facilities, please see Medicare Spending and Use of Medical Services for Beneficiaries in Nursing Homes and Other Long- Term Care Facilities: A Potential for Achieving Medicare Savings and Improving the Quality of Care.