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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.
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. Black Americans Look to Health Plan for New Hope
As black Americans disproportionately suffer from conditions like high blood pressure and diabetes, and roughly 20% lack health insurance, some blacks are looking to the new health care law to reduce many of the health disparities that they face, NPR reports.
“One of the things I've seen as part of the health disparities,” said Donna Thompson, CEO of the Access Network, “is that for many people, they think, ‘If my grandmother died from the results of diabetes, that's probably going to be my legacy also.’ So, there's a huge opportunity with the health care bill” to persuade people to actually get treatment.”
With the health care overhaul expected to insure 32 million currently uninsured individuals, allowing for an opportunity to address chronic disease and focus on preventive care, many, including Rep. Jesse Jackson Jr. (D-IL) who recently held a forum to explain benefits of the bill, view the health care overhaul as a civil rights victory. “I was there in spirit to witness a president who with the stroke of his pen freed more people from 'health carelessness' than Abraham Lincoln freed from slavery,” Jackson said.
Not all believe, however, that the legislation has the ability to eliminate racial disparities. Claudia Fegan, a doctor at the Woodlawn Health Center, a public clinic in Chicago, believes that because millions of individuals will remain uninsured with the new health care law, the system won’t be fair. “There'll be people who have private insurance, there'll be people who have the public program, and there'll be people who are uninsured…As long as we have that multitiered system, we will perpetuate the disparities which people of color suffer more than anyone else” (Corley, 4/22).
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2. AHRQ Issues Annual Quality and Disparities Reports
According to the Agency for Healthcare Research and Quality’s (AHRQ) recently released 2009 National Healthcare Quality and Disparities Reports, gaps in access and quality persist, Medscape Medical News reports.
Among the findings of the reports, which include data based on over 200 healthcare measures, are that obese black, Hispanic, and poor adults, and those without a high school degree are less likely to receive dietary advice from their physician, and, compared to whites, racial and ethnic minorities had lower rates of receiving preventive, pre-surgical antibiotics. In addition, while racial disparities in rates of uninsurance have narrowed over the past 10 years, “disparities associated with ethnicity, income, and education continue to be a major obstacle.”
“‘Despite promising improvements in a few areas of health care, we are not achieving the more substantial strides that are needed to address persistent gaps in quality and access,’ AHRQ Director Carolyn M. Clancy, MD, said in a news release” (Barclay, 4/16).
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3. Health Secretary Addresses Minority Health Issues
Speaking at the National Action Network’s national convention on Wednesday, Health and Human Services (HHS) Secretary, Kathleen Sebelius, said that she is developing a national plan of action to address racial and ethnic health care disparities — something which has never been done before, The Associated Press reports.
Sebelius said that although HHS has been documenting racial and ethnic disparities for 25 years, there has yet to be a plan of action to focus on them. “I’m here to say that’s going to end this year,” she said.
In addition to the action plan, Sebelius said that HHS would address at childhood obesity, also and use social networking platforms to disseminate health information (Scott, 4/14).
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4. Health Care Law Aims to Address Inequities in System
While racial and ethnic health disparities are not a primary focus of the new health reform law, some lawmakers, advocates, and activists say that the legislation may help to address them, the Shreveport Times reports.
The new law is estimated to insure 32 million of the 46 million individuals who are currently uninsured, more than half of whom are people of color. It also expands Medicaid eligibility, increases funding for community health centers, aims to increase and diversify the health care workforce, and increases the collection and reporting of data on race, ethnicity, and language. Aaron Shirley, a physician in Jackson MS, said while the health reform law is not “specific to disparity…Increasing the number of minorities with insurance means more minorities will see a doctor regularly, adopt healthier lifestyles and possibly avoid serious health conditions.”
Others contend, however, that the new law doesn’t do enough to address disparities. “Research here is pretty clear that the health care system is fundamentally broken, (and) no one experiences those flaws more than people of color,” said Brian Smedley, director of the Joint Center for Political and Economic Studies’ Health Policy Institute. For example, the law does not reimburse Medicare and Medicaid providers for interpretation services or direct federal health care resources to underserved communities. But Nancy-Ann DeParle, the White House advisor on health reform, said that while the law is “not everything everyone wanted…it’s a huge step forward in trying to deal with the racial and ethnic and other disparities” (Berry, 4/11).
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5. Sleep-Related Deaths Higher Among African-American Infants in Cook County, Study Finds
A new study from researchers at the Children’s Memorial Research Center found that “African-American infants in Cook County, IL are 12 times more likely to die of sleep-related causes than white infants,” the Chicago Tribune reports.
About 90 sleep-related infant deaths occur in Cook County annually, which include sudden infant death syndrome (SIDS), unintentional suffocation in bed, and deaths that occurred while the infant was sleeping but for which the cause is undetermined. About 30% of these deaths occurred from an undetermined sleep-related cause. The study, which focused on 67 undetermined deaths between 2005 and 2007, found that African-American babies were nearly 17 times more likely to die of an undetermined sleep-related cause. Fifty-seven percent of these deaths occurred while the infant slept in bed with an adult, 21% occurred when the infant was sleeping alone, but was placed somewhere other than a crib or bassinet (i.e. couch or floor), and 8% of these undetermined deaths occurred when the infant had been put to sleep on its back in a crib or bassinet, as recommended by experts.
As nearly 20% of African-American infant mortality deaths are due to sleep-related causes compared to less than 5% for whites, Jenifer Cartland, director of the Children’s Memorial Research Center’s Child Health Data Lab said that, “[d]ecreasing the disparity between African-American and other ethnic groups is a major national public health goal” (Shelton, 3/28).
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6. Asian-American Women’s Health a Concern
The Fresno Bee reports on two new studies published in the American Journal of Public Health that suggest that immigration status, racial discrimination, and English proficiency affect health outcomes for Asian-Americans in California.
In a study looking at breast cancer survival rates, researchers from the Cancer Prevention Institute of California found that U.S.-born Asian women of six ethnic groups were more likely to be diagnosed with breast cancer while foreign-born Asian women were more likely to die of it. In a separate study from researchers at the University of California at Los Angeles School of Public Health, researchers found that Asian-Americans of the same six ethnic groups who reported racial discrimination reported a greater number of days in poor health than those who reported less discrimination.
“‘We should use this information as a starting point to look at what the needs are and the health disparities,’ said Debbie Tom, a founding board member of Central California Asian Pacific Women, an organization based in Fresno that promotes access to education, health and employment” (Anderson, 3/25).
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7. CDC: Breast Feeding Varies by Race, Place
A new study from the Centers for Disease Control and Prevention (CDC) shows both racial and ethnic and regional differences in breast feeding rates, The Associated Press reports.
Conducting telephone interviews of roughly 100,000 women with a child between 19 and 36 months, the study found that, overall, 73% of mothers in the U.S. said that they breastfeed their babies, though many do not continue the practice weeks or month later. Hispanic women were found to have the highest breast feeding rates “with more than 80 percent initiating breast feeding right after birth and 45 percent continuing at least six months later.” In addition, the report also found stark regional differences in breast feeding rates both within and between racial and ethnic groups. For example, in the East, Hispanics had the highest breast feeding rates, while in some states in the West, including Alaska, Colorado, and New Mexico, white women had the highest rates. Though there is no clear explanation for these findings, “[p]ast studies have shown that the longer Hispanic immigrants are in the U.S., the more accepting they are of using baby formula. They also tend to adopt worse eating habits and lifestyles for themselves.” Others suggest that differences in hospital behavior or in state laws that help to facilitate breastfeeding at work may account for these regional differences.
The CDC’s report was consistent with previous research that found lower rates of breast feeding among women who are younger, low-income, and less educated, and the lowest rates among black women (Stobbe, 3/25).
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8. African-American Youths Account for Half of New HIV Infections; CDC Launches “i know” Campaign to Reach Them
As African-American youths account for half of all new HIV infection cases among Americans aged 13-29, the Centers for Disease Control and Prevention (CDC) recently launched “i know,” a social media initiative directed toward African-American youth ages 18-24, the Atlanta Journal Constitution reports.
The “i know” initiative, which is part of the CDC’s larger Act Against AIDS campaign, will use social media platforms, like Facebook and Twitter, to get young people talking about HIV. Donna McCree, a behavioral scientist with the CDC’s division of HIV/AIDS Prevention explains, “[t]he whole effort is designed to get them talking about HIV so we can share lifesaving intervention, reduce stigma and increase their knowledge.” Celebrities and individuals living with HIV/AIDS will be among those participating in the campaign.
McCree noted that the spread of HIV epidemic could be attributed in part to a decline in concern about HIV among youth, stigma, “the prevalence of other sexually transmitted diseases, and a lack of health care due to poverty and discrimination, which prevents people from seeking a diagnosis.” She said that the idea behind the “i know” campaign is “to get HIV/AIDS back on the radar screen so people know about the rates of infection” (Staples, 3/24).
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9. Health Bill Will Iron Out Disparities
In an opinion piece in the Atlanta Journal Constitution, director of the Satcher Health Leadership Institute at the Morehouse School of Medicine and former U.S. Surgeon General, Dr. David Satcher, said that the new health reform legislation is “critical to our achieving the overarching goal of eliminating disparities in health.”
Dr. Satcher said that a reformed health care system allows for the opportunity to reduce or eliminate many of our nation’s health and health care disparities, including disparities in access to quality health care, the number of uninsured, and the stigma associated with mental illness. “Without these reforms,” he said, “people will continue to delay getting needed preventive care such as screenings that can detect early prostate, colon and breast cancers and prevent early death.” He referred to a 2005 study in which he was involved that found that 83,500 African-American deaths in 2000 could have been prevented if health disparities had been eliminated in the last century. He concludes by saying that he hopes the new health reform legislation moves the country in a direction in which the health care system is more “balanced” between health promotion, disease prevention, early detection, and universal access to care. “As long as there are disparities among different ethnic and racial groups, we as a nation are not living up to our commitment to life, liberty and the pursuit of happiness for all Americans” (Satcher, 3/23).
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10. Asians Differ When it Comes to Rates of Disease
The San Francisco Chronicle reports on recent research documenting variations in Asian and Pacific Islander health through subgroup analysis, and the potential misconceptions that can arise when Asians are viewed as a homogenous group.
“‘Because of the way the data has been framed in the past, when you group everyone together you don’t see the disparities,’ said Marguerite Ro, deputy director of the Asian and Pacific Islander American Health Forum.” To address this, the American Journal of Public Health recently published its first ever issue looking specifically at the health of Asian and Pacific Islander populations. The issue includes studies examining breast cancer and heart disease rates for Asian ethnic groups — two diseases for which more generalized research may mask substantial subgroup variation. For example, one study found that while Asian American women as a whole are half as likely to die from heart disease as white adults, “Native Hawaiian and Pacific Islander adults, who are often included with Asians in health studies, are 40 percent more likely to be diagnosed with heart disease than white adults.”
In discussing the new data that has resulted from studies such as these, Ro said, “[w]hat we need to do now is point out disparities and not continue to make assumptions and base resource allocations on stereotypes” (Allday, 3/19).
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11. Vitamin D Caution Sounded: Wake Forest Baptist Study Finds Higher Calcium Levels in Diabetic Blacks
A new study in the Journal of Endocrinology and Metabolism found that vitamin D — which is often recommended for those with osteoporosis and/or low vitamin D levels — may increase the risk of heart attack in blacks with diabetes, the Winston-Salem Journal reports.
In an analysis that included 340 blacks with Type 2 diabetes, researchers from the Wake Forest University School of Medicine found that “having higher circulating levels of vitamin D was associated with more calcium in the walls of large arteries in blacks with diabetes, an effect that can lead to clogging of the arteries.” This is contrary to what is believed to occur in white diabetics.
Dr. Barry Freedman, the chief of nephrology at the medical school, said that doctors may want to limit the use of vitamin D in black diabetics until more research has been conducted on the effects of the supplement on the heart. “‘We should more clearly determine the effects of supplementing vitamin D in black patients with low levels based on existing criteria, and should not assume that the effects of supplementation will be the same between the races,’ Freedman said” (Craver, 3/16).
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12. Death Rates Tied to Ethnicity
The Press-Enterprise reports on a new study from the Riverside County Department of Public Health that found racial and ethnic disparities in several leading causes of death in Riverside County in 2005, including diabetes, suicide, liver cancer, and lung disease.
According to the report, the death rate due to homicide for blacks was seven times the rate for whites, and blacks were also twice as likely as whites to die from diabetes; Hispanics were 15% more likely to die from stroke than whites but 50% less likely to die of liver cancer; and the rate of suicide deaths for whites was 30% higher than the rate for blacks and the rate of death due to lung disease for whites was also 30% higher than the rate for Hispanics. The report also looked at hospitalization rates for asthma, diabetes, and heart, and found that blacks had a higher rate of hospitalizations for all of these conditions except for heart disease.
Marshare Penny, an epidemiologist at the Public Health Department and a study author, said, “agencies and organizations need the data to develop programs and target areas that require the most help.” She added, “[a]s far as data goes, it's really a start…[i]f the goal is to eliminate health disparities, it's challenging when you have a diverse population” (Hines, 3/13).
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DISPARITIES IN RESEARCH
13. Changing Patterns in Health Behaviors and Risk Factors Related to Cardiovascular Disease Among American Indians and Alaska Natives
In an article in the current issue of the American Journal of Public Health, researchers from Stanford University and the University of Washington found significant increases in cardiovascular disease risk factors for American Indian and Alaska Native adults over a 10 year period.
Analyzing a sample of 2,548 American Indian and Alaska Natives aged 18 and older in 1995-1996 and 11,104 in 2005-2006 across six cardiovascular disease risk factors (type 2 diabetes, obesity, hypertension, smoking, sedentary behavior, and low fruit and vegetable intake), the authors found that, over the 10-year period, the adjusted prevalence of diabetes increased from 6.7% to 8.5% (a 26.9% increase), obesity prevalence increased from 24.9% to 31.2% (a 25.3% change), and hypertension rose from 28.1% to 29.5% (a 5% increase). With few exceptions, these three conditions increased among all demographic subgroups, including both men and women, and individuals of all educational levels. The largest increase in diabetes prevalence was among older American Indians and Alaska Natives, while the largest increase in hypertension was observed among those residing in the Northern Plains. Nearly all of the demographic subgroups examined showed large increases in obesity prevalence over the 10-year period. In addition, American Indians and Alaska Natives had high rates of sedentary behavior and low levels of fruit and vegetable intake at both time periods, and smoking rates remained high between 1995-1996 and 2005-2006.
The authors concluded that full funding of Indian Health Service (IHS), — the agency that provides health care to 564 federally recognized tribes across the U.S. — the inclusion of urban populations in IHS funding, as well as the use of community-based participatory research are needed to improve the health of American Indian and Alaska Native populations. (Jernigan, VB, et al., “Changing Patterns in Health Behaviors and Risk Factors Related to Cardiovascular Disease Among American Indians and Alaska Natives,” American Journal of Public Health 100, no. 4: (2010): 677-93)
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14. Race Versus Place of Service in Mortality Among Medicare Beneficiaries with Cancer
In a new study in the journal, Cancer, researchers from Dartmouth found that place of service may partially explain the higher mortality experienced by African-American Medicare beneficiaries with cancer compared to their Caucasian counterparts.
Analyzing 201,305 Medicare beneficiaries with a breast, lung, colorectal, or prostate cancer diagnosis between 1998 and 2002, the authors found that while African Americans had a higher likelihood of all-cause and cancer-specific mortality both 1 year and 3 years after diagnosis than Caucasians (cancer-specific: 1-year odds ratio [OR], 1.13; 3-year OR, 1.23), excess mortality was no longer observed for African-American patients who attended National Cancer Institute (NCI)-designated comprehensive or clinical cancer centers (cancer-specific mortality: 1-year OR, 0.95; 3-year OR, 1.00). In addition, when the models were stratified by race, the researchers observed a decrease in the likelihood of 1-year and 3-year mortality for both Caucasian and African-American patients who attended NCI centers.
The authors said that their study “provides evidence that when African-American and Caucasian cancer patients attend similar types of specialized cancer care settings, all-cause mortality and cancer-specific mortality are similar,” while noting that several other factors likely play a role in cancer disparities. (Onega, T, et al., “Race Versus Place of Service in Mortality Among Medicare Beneficiaries with Cancer,” Cancer (2010). Epub ahead of print: published online March 22, 2010)
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15. Comparing Methods of Racial and Ethnic Disparities Measurement Across Different Setting of Mental Health Care
In an article published in a recent issue of Health Services Research, researchers from Harvard Medical School and Harvard University found significant racial and ethnic disparities in mental health expenditures using two different methods of measuring disparities that are concordant with the Institute of Medicine definition of health care disparities.
Using a nationally representative sample of data from the 2002 to 2006 Medical Expenditure Panel Survey, researchers analyzed data from 111,914 white, black, and Latino adults and compared total, outpatient, and prescription drug mental health care expenditures. They compared findings using two methods for calculating disparities: rank-and-replace and a combination of health status propensity score with SES adjustment. Researchers found that, regardless of method, racial and ethnic disparities were evident across all three categories of expenditures. On average, whites spent $198 on mental health care, compared with $141 for blacks and $100 for Latinos. Researchers also found a large proportion of disparities in expenditures were attributable to differences in the probability of having any expenditure, highlighting the need for improving access to mental health care for racial and ethnic minorities.
The authors concluded that “eliminating disparities in any use of mental health care will require intervention of multiple levels, reducing the number of uninsured, changing provider practices, and reducing barriers to care.” (Cook, BL, et al., “Comparing Methods of Racial and Ethnic Disparities Measurement Across Different Settings of Mental Health Care.,” Health Services Research (2010). Epub ahead of print: published online March 10, 2010)
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16. National Healthcare Quality and Disparities Reports Released; IOM Provides Guidance on Future Reports
On April 13, the Agency for Healthcare Research and Quality released their annual reports to Congress, the National Healthcare Quality Report and the National Healthcare Disparities Report, which track the changes in a broad array of health care quality and access measures among racial, ethnic, and socioeconomic groups in the U.S.
Among the findings of the 2009 Quality Report are that “rates of avoidable hospitalizations overall and avoidable hospitalizations for chronic conditions were higher among Blacks and Hispanics compared with Whites. Rates were lower among Asians and Pacific Islanders compared with Whites.” The report also noted that improvements in health care quality, especially for the uninsured, are needed, and that patient safety and hospital-acquired infections are two areas that require “urgent attention.”
The 2009 Disparities Report found that disparities persist across all dimensions of health care quality and access, and across many clinical conditions, including those in cancer, heart failure, and pneumonia care which “merit particular attention.” For example “[f]rom 2000 to 2005, disparities in colorectal cancer screening for [American Indians/Alaska Natives (AI/ANs)] have been worsening” with “[t]he gap between AI/ANs and Whites is increasing at a rate of 7.7% per year.” The report also noted that a lack of insurance is an important contributor to disparities.
In related news, a new report from the Institute for Medicine (IOM), Future Directions for the National Healthcare Quality and Disparities Report, concludes that while the National Healthcare Quality and Disparities Reports “have made important contributions in raising awareness of the state of the nation’s health care and in identifying gaps in quality and equity,” the reports can be strengthened by adopting nationally recognized priority areas and selecting measures relevant to them and ensuring that achieving equity is a part of quality improvement, amongst other recommendations. The IOM also recommended that the reports expand the use of sociodemographic data, including granular ethnicity and language need.
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DISPARITIES DATA SPOTLIGHT
Select Health Reform Provisions Scheduled to Take Effect in 2010
While the major reforms to expand access to health coverage will be fully implemented in 2014, there are several key provisions of the new health reform law that are scheduled to take effect in 2010, including the creation of a national high-risk pool for individuals with pre-existing conditions, the creation of a state option to cover childless adults in the Medicaid program, tax credits for small businesses that obtain health coverage for their workers, and the reauthorization of the Indian Health Care Improvement Act.
To learn about other key provisions of health reform that take effect in 2010 and beyond, see the Kaiser Family Foundation’s Health Reform Implementation Timeline.
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