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. Cancer Study Sees Cultural Factors in Racial Disparities

In a new study published in the Journal of the American Medical Association, researchers from the University of North Carolina-Chapel Hill found that, “[d]espite a high likelihood of death, black patients are much less inclined to have surgery for early stage lung cancer than whites, often because of a communication gulf between them and their doctors,” The News & Observer (Raleigh, NC) reports.

In examining roughly 400 patients who were newly diagnosed with lung cancer, the authors found that 55% of blacks compared to 66% of whites decided to have surgery to remove the tumor, despite the fact that it is “the only lifesaving option when cancer is diagnosed early.” They also found that many black patients reported that they didn’t feel comfortable enough with their doctors to discuss treatment options, and many also misunderstood their prognosis. “It’s a frustrating problem,” said lead author of the study, Dr. Samuel Cykert. “It’s not just lung cancer ... It’s everything from using tooth floss to knee replacement surgeries. There are hundreds of categories where disparities systematically exist.” Black patients who were older and single, and those who had more health conditions in addition to their lung cancer, were among those more likely to decline surgery.

The research team suggested that navigators be added to health care teams to help discuss treatment options with patients (Avery, 6/16).

TOP

2. Patterns: Uninsured More at Risk Even in Hospitals

The New York Times reports on a new study in the Journal of Hospital Medicine that finds that the uninsured patients who are hospitalized for heart attacks and strokes are more likely to die than individuals who are otherwise similar, but are privately insured.

Using the 2005 Nationwide Inpatient Sample, researchers from Harvard Medical School and Brigham and Women’s Hospital in Boston looked at roughly 150,000 discharges of nonelderly adult Americans who were admitted to hospitals for heart attack, stroke, or pneumonia. The authors found that, even after controlling for factors like health and socioeconomic status, uninsured patients admitted for heart attacks or strokes were more likely to die in the hospital than their privately insured counterparts (52% and 49%, respectively).

To help explain the findings, lead author of the study, Dr. Omar Hasan—who was surprised by the magnitude of the differences—suggested that patients who have difficulty accessing care may present to hospitals with more advanced disease, noting that the uninsured often delay seeking care (Rabin, 6/14).

TOP

3. Dillard, LSU Health Sciences Center Get Minority Health Research Grant

The National Institutes of Health has awarded Dillard and the Louisiana State University Health Sciences Center a five-year, $6.5 million grant to research health disparities at the gene level, The Times-Picayune (New Orleans, LA) reports.

The grant will be used to research the potential genetic reasons why prostate cancer is especially aggressive in African-Americans; to study the relationship between cervical cancer and viruses; and to research the effects of genetics on childhood asthma and obesity. The grant will also help to support community programs to increase minority involvement in clinical trials, in which participation in has been historically low. The research teams want to be clear, however, that minorities are not the only individuals subject to these disparities, which is why the research is being done at the gene-level. “They happen across the spectrum of humanity,” said, Dr. John Estrada director of education and community services at LSU’s Stanley S. Scott Cancer Center. “In addition to working at Dillard and LSU Health Sciences Center, center personnel will collaborate with LSU-run hospitals, Children's Hospital, Ochsner Medical Center, LSU Health Sciences Center's school-based health clinics and community clinics run by EXCELth Inc., a private, nonprofit group” (Pope, 6/10).

TOP

4. Harrisburg Groups Helps Gays and Lesbians Overcome Health Disparities

“After years of focusing on helping people affected by HIV/AIDS,” the AIDS Community Alliance, an organization that provides a range of services to those affected by HIV/AIDS in south central Pennsylvania, recently launched the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community Health Initiative, to help tackle other health disparities gays and lesbians face, The Patriot-News (Harrisburg, PA) reports.

Last fall, the AIDS Community Alliance determined that they would begin to address other health disparities as outlined by the Gay and Lesbian Medical Association, including mental health, cancer, substance abuse, and health communication. “This is a big stretch,” said Philip K. Goropoulos, president and CEO of the AIDS Community Alliance. “We’ve had an HIV prevention program for a number of years now, but this is a step in a new direction.”

The group recently convened a forum on health disparities among the lesbian, gay, bisexual, and transgender (LGBT) community in south-central Pennsylvania (Fishlock, 6/9).

TOP

5. Local Black Unemployment Rate Third Highest Among 50 Major Cities

According to a new study from the Economic Policy Institute (EPI), African-Americans in the St. Louis metropolitan area were twice as likely as whites to be unemployed in 2009, the St. Louis Post-Dispatch reports.

The report, “Uneven Pain: Unemployment by Metropolitan Area and Race,” which ranked the nation’s 50 largest metropolitan area using national and local datasets, found that the black unemployment rate in St. Louis was 16.9% in 2009, the third-highest rate for blacks in the nation behind Detroit (20.9%) and Minneapolis (20.4%). The unemployment rate for whites in 2009 was 8.4%. In helping to explain the findings, EPI noted that low employment was not simply a factor of low educational attainment, citing data from Minneapolis and Sacramento which showed that racial and ethnic disparities in unemployment persisted even after controlling for education. Despite this, Claude Brown, president of the St. Louis chapter of the NAACP said, “We can put a minimal amount of blame on people for not hiring minorities. But most of the blame has to go to the educational system. And that blame falls on all of us.”

“Nationwide, the EPI study found white unemployment above 11.3 percent in just one metropolitan area. Conversely, Hispanic unemployment topped 11.3 percent in nine urban regions, and African-American joblessness exceeded that percentage in 14 cities,” highlighting the disproportionate impact the recession has had on communities of color (Giegerich, 6/9).

TOP

6. State’s Health Coverage Still High

According to a report from the Urban Institute, the 2006 Massachusetts law that subsidized health insurance coverage for thousands of low- and moderate-income residents, helped keep uninsured rates relatively stable over the past year despite the recession, and also helped to close or narrow racial and ethnic disparities in rates of coverage, The Boston Globe reports.

Comparing the results of a random telephone survey of 3,165 adults conducted in October and November 2009 to the results of similar surveys conducted during the previous three years, the report found that 4.8% of nonelderly adults in Massachusetts were uninsured, which is similar to the previous year, and the lowest uninsured rate in the nation. Additionally, the report found that minorities and whites report similar rates of insurance coverage, and “by the fall of 2009, minorities were less likely than white adults to say that they went without health care because of the costs … attributing those gains to greater enrollment by minorities in the state’s subsidized insurance, which typically has lower charges for doctors’ visits and other care.” Despite this, people of color were more likely to report using the emergency room for non-urgent care, more likely to report not having a regular doctor, and less likely to say that their quality of care was very good or excellent.

Rev. Hurmon Hamilton, pastor of the Roxbury Presbyterian Church and president of the Greater Boston Interfaith Organization, described the law as a “wonderful step in the right direction,” but said that it is “by no means the last chapter in the book of disparities” (Lazar, 6/9).

TOP

7. HHS Advisors Consider Mapping Disparities Via HIT

In a recent meeting, the Department of Health and Human Services’ Health Information Technology (IT) Policy Committee explored approaches to reducing racial and ethnic and other disparities in health care access and quality through the use of health IT, Government Health IT magazine reports.

In the June 4th meeting, the advisory committee sought solutions to disparities from providers who work with underserved groups, which the committee would then build on for future meaningful use of electronic health records (EHR) requirements. The first stage of proposed meaningful use requirements, which can be defined as the use of certified EHR technology to measurably improve population health, calls for providers to collect data on patients’ race, ethnicity and language, and in 2011, providers will also need to produce quality reports by race, ethnicity, and language. Some speakers suggested that reducing health disparities be included as a quality measure that providers must report in order to be eligible for meaningful use incentive payments. Others suggested that providers use electronic data to monitor and evaluate reductions in disparities among their patients. Work-group member and president and CEO of the Institute for Family Health, Dr. Neil Calman, said that a mechanism to monitor disparities after widespread adoption of health IT was needed, but cautioned that “if we don’t get this right, we’re going to do damage,” noting that if only a small number of providers qualify for meaningful use incentives disparities could continue to grow” (Mosquera, 6/7).

TOP

8. Meharry, Ministers Team Up to Fight HIV/AIDS in Nashville

The Metropolitan Interdenominational Church and Meharry Medical College have each received a five-year, $2 million Capacity Building grant from the Centers for Disease Control and Prevention (CDC) to help launch HIV/AIDS prevention programs to decrease the rate of HIV infection among African Americans, The Tennessean (Nashville, TN) reports.

As convening forums and summits on HIV/AIDS prevention strategies that will attract clergy is a primary focus of the Capacity Building grant, Metropolitan Interdenominational will use its third grant from the CDC to continue to create “clergy circles,” groups of clergy who participate in, and ideally sustain, HIV/AIDS curriculum-based programs. The church will also use funds to continue relationships with divinity schools and train future clergy. Meharry Medical College will use its grant for Project SAVED (Strengthening Access Via Empowerment and Diligence), a program that uses a 22-member advisory committee composed of ministers, health care providers, and Historically Black College and University leaders to develop new prevention programs, activities, and testing opportunities in 11 Southern states. “Sometimes those from the medical community don’t have access to people in the faith community and sometimes we don’t have access to the medical community,” said Rev. Sherman Tribble of New Visions Baptist in Donelson, TN who is a member of the Project SAVED advisory Committee. “It’s rare for a medical school to get involved … We may see it one way and other service providers see it another. But we’re all doing our part.”

Though Meharry Medical College and the Metropolitan Interdenominational Church work independently, they will collaborate at times (Humbles, 6/7).

TOP

9. Multiracial Patients Struggle to Find Donors for Bone Marrow Transplants

As only 3% of the 8 million donors listed in the National Marrow Donor Program’s (NMDP) “Be the Match” registry are of mixed-race, multiracial patients often have difficulty finding a match for bone marrow transplants, The Washington Post reports.

“Once considered a last-ditch treatment, bone marrow transplants increasingly are being used with success to treat a growing variety of life-threatening disorders, including sickle cell anemia and many cancers, and are recommended at much earlier stages and at younger ages, when patients tend to fare better.” But as a recipient is much more likely to “match” with a donor from the same racial or ethnic group, many multiracial individuals struggle to find potential donors. “‘It’s like trying to find a needle in a haystack,’ said Krissy Kobata, 27, the daughter of a white mother and a Japanese father who has been searching for a donor for two years.” According to the U.S. census, about 7 million individuals self-identified as multiracial in 2000, and that number is projected to be about 25% higher today. “‘This is a growing challenge that we face as the world expands and there are more mixed-race kids,’” said Willis Navarro, medical director of transplant services for the NMDP, who, himself, is of mixed-race. Navarro added that donor shortages also pose challenges to African American patients who are more a mixture of races (Boodman, 6/1).

TOP

10. For Many Women of Color, Economic Hedge Against Vagaries of Life is Nonexistent

A column in The Commercial Appeal (Memphis, TN) discusses a study from the Insight Center for Community and Economic Development that examines the wealth gap for women of color.

The study, “Lifting as We Climb: Women of Color, Wealth, and America’s Future,” by Mariko Chang, details that median wealth is lower for women of color relative to white women, and can have implications for economic security. For example, while the median wealth for both nonelderly adult women of color and nonelderly white women is relatively low ($0 and $2,600, respectively), the median wealth for nonelderly adult divorced women of color and widowed women of color is significantly less than the median wealth of their white counterparts (divorced: $4,200 vs. $52,120; widowed: $38,400 vs. $136,000). Additionally, more than a third of Hispanic women and one quarter of black women “have no relationship with a mainstream financial institution,” though it is an important step in accumulating assets.

According to the study, the reasons why women of color have difficulty accumulating wealth include having lower-paying jobs that lack pensions and retirement plans, being less likely to own stock, own a home, or be a business owner, and being more likely to have college loans. Chang adds that some government aid policies also make it difficult to accumulate savings. “‘Without savings or wealth of some form, economic stability is built on a house of cards that quickly crumbles when income is cut or disrupted through job loss, reduced hours or pay, or if the family suffers an unexpected health emergency,’ wrote Chang” (Thomas, 5/30).

TOP

11. Report Shows Hardship Amid Affluence in Area

Though Anne Arundel County in Maryland is relatively affluent, a new report, “Poverty Amidst Plenty: The Two Faces of Anne Arundel County,” has documented stark disparities between the rich and poor in the County, The Capital (Annapolis, MD) reports.

Despite nearly 40% of families in Anne Arundel earning at least $100,000 per year, 4% of families have annual incomes below the federal poverty line (about $22,000 for a family of four in 2008), including about 8% of African-American families. Additionally, 11% of adults are uninsured, residents tend to live in racially segregation neighborhoods, and the number of food stamp requests has increased 50% between 2006 and 2008. On the positive side, high school graduation rates in Anne Arundel County are higher than the state average, and the gap in graduation rates between African-American and whites has decreased in recent years. Underscoring the importance of the report, Bess Langbein, executive director of the Community Foundation of Anne Arundel County, which commissioned the study in partnership with the Anne Arundel County Partnership for Children, Youth and Families said, “We need to have an in-depth understanding of what the most pressing needs are in the community and where the gaps are so we can have the most impact” (Wood, 5/30).

TOP

12. From Rats to Heaters, Doctor-Lawyer Team Fights Barriers to Family Health Care

The Washington Post reports on “a medical-legal partnership between Children’s National Medical Center and the Children’s Law Center that helps patients overcome legal challenges that threaten the care of patients.”

The partnership, which began in 2002, and is one of 85 partnerships in 37 states, is the only one in the Washington area. Through the partnership, doctors and lawyers work together, operating through four clinics in D.C. run through the Children’s National Medical Center. “Their shared goal is to overcome legal and social challenges that threaten the care of their patients—low-income children, predominantly African American, and virtually all covered by Medicaid.” As doctors are finding that patients are increasingly entering hospitals with health symptoms related to social and legal issues, lawyers train pediatricians to screen for potential “red flags” during examinations, including housing conditions, like mold or pests, and school absenteeism. “‘If a child comes in and they’re failing kindergarten, or their asthma isn’t getting better because of substandard housing conditions, it gives us a chance to do something about them,’ said Alsan Bellard Jr., medical director of two clinics in Southeast Washington.” In one of the four health centers run by the Medical Center, doctors typically refer about 10% of the 100-150 patients they see each day to a lawyer.

While other primary-care physicians in the D.C. area would like to participate in the program, funds are currently lacking to hire more full-time staff lawyers. The law center, which receives part of its funding from a D.C. government grant, will soon learn if their funding will be maintained for the upcoming year (Sun, 5/26).

TOP

13. Baltimore’s Health Disparities Revealed in Report; Inequalities Fall Along Education, Income Lines, Study Finds

Finding that residents who are less educated and who have lower incomes have higher morbidity and mortality in Baltimore, the Baltimore Health Department gave the city a “D” on its first Health Disparities Report Card, The Baltimore Sun reports.

In Baltimore’s first effort to measure the extent of health disparities in the city, researchers found that those with a high school degree or less had a higher mortality rate than those with a bachelor’s degree or higher (1,950 vs. 730 per 100,000 people); blacks had a higher mortality rate than whites (1,100 vs. 850 per 100,000 people); and some of the largest disparities were observed between residents who earned less than $15,000 and those who earned more than $75,000. Explains Ryan Petteway, an epidemiologist with the Health Department, “We wanted not just to point out disparities that everyone knows are there, but to understand why the disparities are there.”

“Health officials said they need to engage all departments in the city, including zoning, planning, parks and housing in solutions, particularly for neighborhoods that lack places to shop for good food or recreate and have high crime rates. The officials also will need to share the data with local and national institutions such as hospitals and non-profits that develop programs aimed at improving health outcomes” (Cohn, 5/25).

TOP

14. Culture of Caring: Hospitals Reaching Out to Region’s Cultural Diversity

As the racial and ethnic diversity of Central Florida continues to increase, “local health care providers and educators are searching for ways to better serve them,” the Orlando Sentinel reports.

Twenty-five percent of the population is Central Florida is Latino, and, according to the U.S. Census, Florida has the third largest number residents who do not speak English. In order to better meet patients’ needs, area hospitals and universities have “instituted programs and courses designed to increase the number of health care workers who can provide linguistically and culturally sensitive services,” like a course on cultural competency at the University of Central Florida’s College of Nursing, and an interpreter program for employees at Orlando Health. Explaining why culturally competent care make sense, Bernardo Ramirez, assistant professor of health services administration at the University of Central Florida said, “It not only allows health care providers to serve more patients, it also allows patients to use these services more effectively so they can have better health outcomes.”

“Although hospital officials and educators agree there is a need for more doctors, nurses and other medical professionals who can serve Central Florida's diverse community, they are all working together to address this critical need” (Quintero, 5/24).

TOP

15. Rural Ohio Facing Doctor Shortage

With more than a million Ohioans expected to be newly insured in 2014, the shortage of primary care doctors in the state could get worse, especially in rural communities, CentralOhio.com reports.

According to the Ohio State Medical Board’s public registry, one quarter of Ohio’s counties are medically underserved, defined by the Health Resources and Services Administration (HRSA), an agency within the U.S. Department of Health and Human Services, as a county having more than 2,000 residents for every one primary care doctor. As the registry includes an unknown number of non-active physicians which likely understates the physician-to-doctor ratio, there is already a shortage of primary care practitioners in many parts in the state, and 1 million Ohioans are expected to gain health insurance in 2014 due to the recently-passed health care law, Ohio’s primary care workforce shortages could get even worse. Ed Salsberg, director of the American Association of Medical Colleges’ Center for Workforce Studies said, “I do expect to see that growth, but I do want to be clear that it’s going to be a challenge, and a greater challenge for rural and poorer communities.” Martin Kramer, a spokesperson from HRSA, explained that “people in rural areas have a harder time accessing health care because they have greater distances to cover.”

Some suggest that loan repayment programs for graduates who practice in underserved communities, and increased Medicare and Medicaid reimbursement rates could help draw students to the specialty which is at “the lower end of the physician pay scale.” At The Ohio State University College of Medicine, having all students to work with a primary care doctor and targeting students from underserved communities for admission—who are more likely to practice in underserved communities – has increased the number of students set to practice family medicine by 40%. Keely Harding, legislative co-chairwoman from the Ohio Association of Advance Practice Nurses, believes that part of the solution is already in place. She says that advance practice nurse—who, if they have a masters degree or higher, enter the primary care workforce at nine times the rate of doctors—will be part of the solution. “‘I think there are going to be plenty of patients to go around for physicians and advanced practice nurses,’ she said” (Zimmer, 5/24).

TOP

16. Tackling Asian American Health Disparities

In a conversation with Kathy Lim Ko, president and CEO of the Asian and Pacific Islander American Health Forum, NPR examines health and health care disparities in the Asian-American community, and ways to address them.

Ko explained that, despite the “model minority myth for Asian-Americans, Native Hawaiians and Pacific Islanders,” some Asian subgroups suffer from disproportionately high rates of health and health care problems, disparities that are often only revealed once the data has been disaggregated. For example, she referred to a recent study that found that Korean children were four times more likely to lack health insurance than non-Hispanic white children in California. She said that culturally appropriate care, including language access, is an important factor in helping to reducing these disparities. She also noted that, at least anecdotally due to a dearth of data, Southeast Asian and Native Hawaiian and Pacific Islander communities face specific health and health are challenges, and high rates of uninsurance along with poor access to care are particular problems for the Asian-American community.

Though Ko said that expansions in coverage under the new health reform bill will directly affect Asian-Americans, when asked what she would like to see addressed moving forward, she mentioned language access and coverage issues, including coverage of legal immigrants in Medicaid (Keyes, 5/24).

TOP

DISPARITIES IN RESEARCH

17. Differences in Prevalence, Treatment, and Outcomes of Asthma Among a Diverse Population of Children with Equal Access to Care

Despite universal health insurance coverage through the Military Health System (MHS), the authors of a new study in the Archives of Pediatrics & Adolescent Medicine found that, compared to white children, “the prevalence of asthma among black and Hispanic children was significantly higher and their outcomes were often worse.”

To investigate whether racial and ethnic disparities in the prevalence, treatment, and outcomes of diagnosed asthma were minimized among children with similar coverage of and access to medical care, the authors analyzed the claims data of 822,900 children enrolled in the MHS. After adjusting for several factors, they found that black and Hispanic children in all three age groups were significantly more likely to be diagnosed with asthma than white children (odds ratios [ORs] ranging from: 1.16 to 2.00), and black children in all age groups and Hispanic children aged 5-10 years were more likely to have any asthma-related potentially avoidable hospitalizations and emergency room visits (ORs ranging from: 1.24 to 1.99) and were also less likely to see a specialist than white children (ORs ranging from 0.71 to 0.88). In addition, black children aged 5-10 years were also significantly more likely than white children to have filled any prescription for asthma, while Hispanics aged 11-17 years were significantly less likely to have an asthma-related prescription filled (OR black: 1.09; OR Hispanic: 0.81).

The authors conclude that their findings “suggest that eliminating racial and ethnic disparities in health care likely requires a multifaceted approach beyond universal health insurance coverage.” (Stewart, KA, et al., “Differences in Prevalence, Treatment, and Outcomes of Asthma Among a Diverse Population of Children with Equal Access to Care,” Archives of Pediatrics & Adolescent Medicine, 164, no. 8 (2010). Early release article: published online June 7, 2010)

TOP

18. Self-reported Fluency in Non-English Languages Among Physicians Practicing in California

In an article published in the journal, Family Medicine, researchers from the University of California, Los Angeles and the University of California, San Francisco found that international medical graduates (IMGs) make a significant contribution “to the diversity of languages spoken by California physicians.”

Analyzing responses to questions about ethnicity and language fluency asked of physicians practicing in California in the California Medical Board Survey, the authors found that 42% of California physicians reported speaking at least one language other than English fluently. When they examined IMGs and US medical graduates (USMGs) separately, they found that 56% of IMG physicians compared to 37% of USMG physicians reported fluency in one other non-English language. Additionally, while the majority of physicians with “fluency in Asian languages was primarily restricted to physicians who are of Asian race/ethnicity,” the majority of physicians in California who reported being fluent in Spanish were non-Latino white. Further, they found that while Latino USMGs and Latino IMGs reported comparable rates of Spanish language fluency (84% vs. 95%, respectively), IMGs were much more likely to report fluency in Asian and Pacific Islander languages than were USMGs.

The authors write that “this type of data collection of physician language fluency should be incorporated into other physician workforce databases, particularly in states with changing linguistic diversity.” They also suggest that future research examine how language fluency and practice location relate.

(Moreno, G, Walker KO, and K Grumbach, “Self-reported Fluency in Non-English Languages Among Physicians Practicing in California,” Family Medicine, 42, no. 6 (June 2010): 414-420)

TOP

DISPARITIES DATA SPOTLIGHT

The results of the May 2010 Kaiser Health Tracking Poll found considerable differences in opinions of the new health reform law by race and ethnicity. Thirty-five percent of whites had a favorable opinion of the law compared to 64% of blacks and 54% of Hispanics. This may be explained, in part, by racial and ethnic differences in beliefs about how individuals will be personally impacted by health reform. About half of blacks and Hispanics compared to 22% of whites reported they think they and their families would be better off under the new law.

To view more results from the survey, please see the May 2010 Kaiser Health Tracking Poll.