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. On the Border, Long Lives Despite Dismal Statistics

A recent article in the New York Times discussed the "Hispanic paradox" of residents living in Hidalgo County Texas, who despite challenges accessing health care and poor health indicators, "live on average two years longer" than most Americans or Texans.

Hispanic residents along the US-Mexico border are more likely to be diagnosed with diabetes, obesity, and kidney disease than the average American. "Our youth are increasingly obese, increasingly diabetic, and we're seeing complications earlier and earlier," said Dr. Carlos Cardenas, a practicing physician and chairman of the board at Doctors Hospital at Renaissance in Edinburg, in the lower Rio Grande Valley. Hispanics also have higher uninsured rates, yet at 80 years their average life span is two years longer than the average American or Texan. "People here routinely die at 103, 99, 97, 90," said Ms. Gomez, the executive director of the Brownsville Community Health Center, a safety-net organization that provides primary care to those with nowhere else to get it. Some researchers believe culture plays an important role, suggesting that "immigrant diet," physically-demanding jobs, and even religious faith and family traditions may help explain the longer life expectancy. "People here are so poor that we grow a lot of our own food, we buy only what we need…and in many cases fast food has really not been introduced," Ms. Gomez said. Despite a lack of health insurance, Mexican-American residents cross the border to see a doctor or refill prescription medicine. Furthermore, grandparents are seldom placed in a nursing home, instead they remain in the care of the family unit which according to experts "prevents loneliness and creates a will to live." Besides the cultural argument, researchers have focused on natural selection to explain the longer life expectancy. According to Dejan Su, director of the South Texas Border Health Disparities Center at the University of Texas-Pan American, "those who are not so healthy, are more likely to stay in their native countries.

Dr. Dejan Su also notes that it is unclear whether seasonal migrant workers or illegal immigrants living in substandard housing conditions are taken into account when calculating Hispanic life expectancy. (Ramshaw, 1/15)

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2. Broad Racial Disparities Seen in Americans' Ills

The New York Times reported on the first study published by the Centers for Disease Control and Prevention to highlight racial health disparities across all Americans.

The report is the first one from the CDC "detailing racial disparities in a broad array of health problems," and although its primary focus was on racial and ethnic differences it includes some data by income level, region, age, and sex.  Many of the findings reinforced those of prior studies, including the disproportionate effect of AIDS, stroke, and heart disease on racial and ethnic minorities, the report also included data on disparities in teen pregnancy rates, suicide rates, prescription drug overdose, and binge drinking.  Death rates from prescription drug overdose are higher among whites than blacks due to accessibility through health insurance and teenage pregnancy rate remains stable although Hispanic teenagers are three times more likely to become pregnant than whites.  "We wanted to shine a spotlight on the problem and some potential solutions," said Dr. Thomas R. Frieden, the CDC director, noting that "some of the figures, like the suicide rate for young American Indians, are just heartbreaking" who also found that American Indians and Alaska Natives are twice as likely to die in car crashes than any other group.  Health differences by state were also documented.  For example, people in West Virginia, Kentucky and Tennessee reported the fewer "health days" per month compared to residents of Utah, Connecticut, and North Dakota. 

Dr. Friedman noted that two legislative laws, the 1994 Vaccines for Children program, and the 1975 earned-income tax credit have helped decrease racial health gaps (McNeil 1/13).

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3. Will Digital Technology Reduce Gap in Health Between Rich and Poor?

A recent article from The Center for Public Integrity discussed the concerns of small practice and low-income providers, who disproportionately serve low-income individuals have regarding the possibility that Health Information Technology (HIT) requirements may increase the "digital divide" and contribute to health disparities.  

According to a report from the Department of Health and Human Services Agency for Healthcare Research and Quality, there is a strong association between health and income, yet within each income bracket racial and ethnic disparities exist.  Although various efforts will be required to eliminate health disparities, Nancy Szemraj a spokesperson for HHS said, "HHS believes that the use of health information technology will play a critical role in eliminating health disparities."   However, a study from 2009 found that hospitals serving predominantly low-income patients are less likely to adopt electronic medical records citing costs as a barrier, and those without, provide a lower quality of care. The high cost of adopting HIT is a challenge for some solo-practicing doctors and small clinics, who will have greater difficulty meeting the requirements set forth in the Affordable Care Act (ACA).  Some money to help providers get automated was included in the stimulus legislation, but affordability remains a concern for individual physicians.  The federal government has released additional funds to aid low-income providers with the purchase. 

The goal of HIT is to aid health care providers increase preventive care services and improve the health of patients with chronic conditions by having access to patients' information, but there is a dearth of evidence demonstrating HIT's role in reducing disparities.  The Open Door Family Medical Center clinic in Westchester County, N.Y. experienced vast improvements in the health of its patients after HIT adoption.  Blood pressure stabilization increased from 41 percent to 65 percent while diabetic patients' medical condition improved from 36 percent to 47 percent.  Medical schools like Morehouse School of Medicine have also taken advantage of HIT tracking system to further research health outcomes of African Americans.

The Center for Public Integrity notes that although HIT research is limited, examples of health improvement in low income patients is shown after clinics adopt digital technology (Schwartz 01/11).

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4. Preventing Heart Risks at the Root: Childhood

A recent article from The New York Times discussed the findings of two studies published in the journal Circulation which found that preschool children with at least one parent who smokes were more likely to be hypertensive and teenagers who consume excessive amounts of sugar had worse cholesterol levels. Both hypertension and poor cholesterol levels are contributing factors of heart disease.

The first report examined 4,236 5-year-old children in 2007-2008 who underwent physical and cognitive assessments before beginning school. The authors found that children with a parent who smokes were more likely to have higher blood pressure readings than their classmates.  Dr. Giacomo D. Simonetti, lead author of the study, also identified being overweight and having a parent with hypertension as contributing factors to adolescent hypertension.  Dr. Simonetti noted that "if you have a kid who has high blood pressure, it's likely he will continue to have high blood pressure… it's the same for B.M.I." The second study analyzed responses from 2,157 adolescents surveyed by the Centers for Disease Control and Prevention and found that teenagers whose daily caloric intake consisted of more than 30 percent sugar were more likely to have lower HDL, higher LDL, and higher triglyceride blood levels than those with at least 10 percent. Jean A. Welsh, lead author of the study at Emory University, noted that this study was observational and further studies were needed to establish a connection.

Both authors underscored the importance of cardiovascular disease prevention and noted that "prevention of these diseases begins in childhood" (Bakalar 1/10).

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5. State Works to Improve Indian Health

The Billings Gazette (Montana) recently reported on the efforts of the Montana Department of Public Health and Human Services (DPHHS) to improve access to care and health outcomes for its American Indian population.

American Indians represent 7 percent of Montana's population yet have disproportionately higher rates of obesity (42% vs 22.5%) and diabetes (14.4% vs. 6.1%) than whites.  To combat disparities, DPHHS formed and internal tribal working group to bridge communication between the health department and tribal governments.  The tribal working group aims to focus on developing policies and dispersing information to reach different tribes with a goal of improving access to programs the department has to offers.  American Indians in Montana also face a greater number of social challenges, which contribute to health disparities. "The high rates of unemployment, poverty, access to housing and substance abuse on our reservations create social factors that make it difficult for this population to focus on their health," said DPHHS Director Anna Whiting Sorrell, an enrolled member of the confederated Salish and Kootenai Tribes.  DPHHS helps tribal groups connect with housing programs, energy assistance and food banks to help people "focus on their health and prevention of further health care needs."

Other programs including outreach of Medicaid staff to tribal communities, Healthy Montana Kids, and other services help decrease the health gap among American Indians (Uken 01/08).

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6. Homeless Patients Present Unique Problems for Venice Free Clinic

The Los Angeles Times recently reported on the efforts of health care providers to treat members of Culver City's homeless community at Venice Family Clinic, which is thought to be the largest free clinic in the nation.

Los Angeles County has about 48,000 homeless people who are five times more likely to be hospitalized than people living in homes.  "Homeless people generally have multiple health problems that are complex and interrelated, "said John Lozier, executive director of the National Health Care for the Homeless Council.  Medical problems can range from mental illness and communicable diseases, to drug addiction.  Many homeless people neglect their medical problems for a variety of reasons, including a lack of transportation, distrust of doctors and giving priority to finding food and shelter.  Volunteer doctors, dentists, pharmacists, and nurse practitioners come together at Venice Free Clinic to serve 3,700 homeless patients every year.  The clinic operates on a $22 million budget funded by private and public money, as well as donations.  The most common dispensed medicines include ibuprofen, decongestants, cough medicine, antibiotics, and vitamins.  "It's much less expensive to take medical care to them than to let them get so bad that they end up in the ER," said Dr. Theresa Brehove, director of homeless services for the Venice clinic.

The number of homeless people in Los Angeles has declined in the past years due to public and private programs providing affordable housing and social services (Helfand 1/05)

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7. California is Cutting Preventable Hospitalization

The Los Angeles Times recently reported on California's decreasing preventable hospitalization rate while highlighting the high disproportionate hospitalization rate among African Americans.

A recent report from California's Office of Statewide Health Planning and Development noted a decrease in preventable hospitalizations between 1999 and 2008. The report examined 15 conditions including chest pain, pediatric gastroenteritis, and chronic obstructive pulmonary disease, for which a hospital stay is regarded as preventable.  Regardless of improvements, disparities persist among African Americans who experienced the highest hospitalization rate of any racial or ethnic population, at 13%.  Whites (11%), Latinos (8.6%), Asians (6.7%), and Native Americans (3.9%) follow African Americans in hospitalization rates.  A lack of access to regular care was cited as a contributing factor to the disparities.  The hospitalization rate for African Americans living in South Los Angeles was more than three times than state average for hypertension and more than twice the average for congestive heart failure, adult asthma, and lower-extremity amputation.  Hospital readmission rates are of particular concern to health policymakers who see the potential of decreasing costs and increasing patient safety. (Hennessy-Fiske, 1/4)

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8. Study Finds Bright Spots for Rural Health Care

A recent article from The Columbia Daily Tribune discussed the findings of a new report from the Rural Policy Research Institute (RUPRI), which found potential benefits to rural communities in the recently enacted health reform law.

Rural communities face health care challenges including shortages of primary care providers, large uninsured populations, and less access to fruits and vegetables than urban communities.  A 2008 profile of Missouri found that 102 counties contain areas with a shortage of primary care physicians with 27 counties experiencing shortages for the entire area.  According to a study by the Center for Rural Affairs in Lyons, Nebraska, rural children are more likely to be obese and less physically active than children living in urban communities.  The RUPRI report noted that the Patient Protection and Affordable Care Act may increase the availability of preventive care services and improve access to health care in rural areas.  Although benefits to rural areas are evident throughout the legislation, Keith Mueller, chairman of the RUPRI Rural Health panel, noted that the law has been a "tough sell for rural America" citing misconceptions of the law as a barrier.  Brian Dabson, RUPRI's vice president and chief operating officer and University of Missouri research professor, also noted that recent changes to the U.S. House of Representative could threaten implementation of provisions as Republican lawmakers are seeking to repeal the law.

The Rural Policy Research Institute consists of researchers from the University of Missouri and other Midwestern schools (Denney 01/04).

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9. SF Medical Center Offers Cancer Outreach in Jail

The San Francisco Chronicle recently reported on the efforts of California Pacific Medical Center to provide health care services and counseling in breast health to incarcerated women.

Initially, the California Pacific Medical Center established a program to treat black women, and then expanded their efforts to treat uninsured and underinsured women.  The extension of their services to incarcerated women seemed like a natural fit.  "This is definitely an underserved population, and we'd like to extend all our resources to this group of women," said Judy Li, vice president of health system innovation and community benefit for the hospital.  Studies have found that black women are diagnosed with breast cancer at a later stage than white women or develop aggressive tumors at a younger age, both making treatment more challenging. Different studies have also shown that race, poverty, and a lack of insurance are contributing factors to such disparities.  Last year, through the California Pacific Medical Center's programs 367 women were screened for breast cancer and provided some women with free care including chemotherapy, radiation, and cost of surgery.  Women in the San Francisco County Jail receive counseling and transportation services for free mammogram screenings.

Carolyn Dyson, a breast cancer survivor and manager of California Pacific Medical Center's breast health outreach programs advised women that breast cancer "may not wait until you're released" as she spoke to a group of 50 women in SF County jail (Colliver 01/03).

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10. Immigrants to Face New Barriers to Buying Health Insurance

The Salt Lake Tribune discussed the challenges U.S. immigrants face in purchasing health insurance coverage through the new health care law.

Noncitizens are more likely to be uninsured than their citizen counterparts.  For many undocumented immigrants, community health clinics serve as their primary source of care.  They are also able to purchase health coverage through the open market.  Although the health care law will expand coverage to millions of low-income individuals through Medicaid, this program will be off limits to undocumented immigrants, who will continue to make up the largest uninsured group after 2014 when health coverage becomes mandatory.  Low income advocates see this as a public health and as a cost issue for communities that are largely made up of immigrants like Los Angeles or some parts of Utah.  "Having access to primary care keeps patients' chronic diseases controlled and costs in check….we can treat a patient three times a year for about $500, whereas one visit to the ER back in 2006 was more than $800," said Alan Pruhs, associate director of the Association for Utah Community Health.  Pruhs also notes that a majority of the savings are accrued from healthy pregnancies as a baby in the intensive care unit can cost the hospital up to a million dollars.

The health care law plans to increase federal funding to community health clinics which treat largely undocumented immigrants (Stewart 12/31).

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11. Most Social Welfare Programs Closed to Undocumented Immigrants

The Salt Lake Tribute recently reported on the availability of services to undocumented immigrants through state social welfare programs.

With the exception of a few federally funded programs like Women, Infants, and Children (WIC) and emergency medical services, which do not document citizenship status, undocumented immigrants are prohibited from taking part in state social welfare programs.  In Utah, about 13 percent of the population are Latino, yet 40 percent of its WIC program enrollees are Latino.  The WIC program has also increased enrollment by 60 percent over the past three years, noted Colleen Jenson, director of the Weber-Morgan WIC clinic.  The growth in enrollment and the disproportionate representation of immigrants in these programs does not mean citizens are unable to access them.  According to Jennifer Tolbert, a health policy expert at the Henry J. Kaiser Family Foundation, "all citizens qualify, so there's no crowding out of citizens by illegal immigrants."  Social programs like welfare, food stamps, and Medicaid, are unavailable to undocumented immigrants except through their citizen-born children.

WIC programs help maintain the health of a community by providing free immunizations, counseling to quit smoking, free or discounted drugs for communicable diseases,  and counseling on health eating and breastfeeding (Stewart 12/31).

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DISPARITIES IN RESEARCH

12. Social Network Characteristics and HIV Sexual Risk Behavior Among Urban African American Women

A recent study published in the Journal of Urban Health examined the relationship between social network characteristics of African American women at risk of heterosexually acquired HIV, and found that having a risky sexual partner was associated with having a large social network and having more social networks who used heroin or cocaine.

Researchers identified 513 sexually active African American women at risk for acquiring HIV/STIs via heterosexual intercourse.  At risk was defined as having more than two sex partners, an STD diagnosis in the past 6 months, or having a high risk partner.  Women who were HIV positive were excluded from the study.  Participants were asked a series of questions regarding their socioeconomic status, social network information, and alcohol and drug use history.  The study found that more than 50% of the women reported having at least one risky sexual partner (e.g. Injected, smoked crack, had an STD, or was HIV sero-positive) within the past 90 days and 50% of the participants had two or more sexual partners in the past 90 days.  More than 60% of the women were unemployed, reported depressive symptoms, and drug use.  These findings were associated with having a larger social network and having more social network members who used heroin or cocaine.  Women with two or more sexual partners within the past 90 days were more likely to have reported depressive symptoms, to have been homeless within the past six months, and to have used herion or cocaine within the past six months. These findings were associated with belonging to a large personal network, and connecting with network members who provided financial support, or used heroin or cocaine.  The authors noted that older age women were less likely to have two or more sex partners within the past 90 days (p<0.001), but were more likely to have a higher risk partner (p<0.001).

The authors underscored the importance of targeting social networks for intervention and developing HIV-prevention programs that target both the individual and network members.

(Neblett RC, Davey-Rothwell M, .et al. "Social Network Characteristics and HIV Sexual Risk Behavior among Urban African American Women." Journal of Urban Health, (January 2011).)

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13. The Contribution of Geography to Black/White Differences in the Use of Low neonatal Mortality Hospitals in New York City

In a recent study published in the journal Medical Care, researchers evaluated the role geography and hospital characteristics play in a mother's use of hospitals with lower risk-adjusted very low birth weight (VLBW) neonatal mortality rates in New York City, and found that racial differences in distance to top-tier hospitals does not contribute to racial disparities, however, proximity to top-tier hospitals is important to the most vulnerable neonates.

It is well documented that the black community is more likely to have a greater incidence of preterm and VLBW births resulting in racial disparities in infant mortality rates.  Previous studies have made connections between neighborhood characteristics and residential racial segregation to health disparities.  Using data from a 1996 to 2001 study, the researchers identified 1,615 white and 4,947 black mothers of VLBW neonates to evaluate mother characteristics, neighborhood location, and hospital characteristics to explore contributing factors to disparities in infant mortality.  The authors found that black mothers were more likely to deliver at teaching hospitals and less likely to deliver at top-tier hospitals compared to white mothers.  The authors assessed whether proximity to hospitals and access to high-quality providers played a role in racial disparities in health.  They found that black mothers were more likely to live in neighborhoods with a hospital (p<0.001), to travel shorter distances to get to a hospital (p<0.001), and less likely to use a top-tier hospital when it was in their neighborhood (p<0.001) compared to white mothers.  Even when mothers had to travel outside of their neighborhood, black mothers were less likely to deliver in a top-tier hospital (p<0.001) compared to white mothers.  The authors also evaluated the importance of hospital characteristics in influencing where mothers delivered, and found that by taking account a mother's insurance, racial differences in association where mothers delivered were reduced.  In 2000, black mothers were more likely to deliver in a hospital that had a large percentage of discharges that were paid by Medicaid.

The authors concluded that several factors have to be taken into account when understanding racial disparities in infant mortality rates including hospital characteristics, geography, and personal characteristics.  The authors concluded that in addition to more research being needed to understand disparities, this study underscored the importance of geographic proximity and insurance type on the choice of hospital.

(Hebert PL, Chassin MR, et al. "The Contribution of Geography to Black/White Differences in the Use of Low neonatal Mortality Hospitals in New York City." Medical Care, 49, no. 2. (February 2011): 200-206.)

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14. The Role of Physician Involvement in Latinas' Mammography Screening Adherence

A recent study in the Women's Health Issue Journal examined whether physician involvement predicted adherence to the American Cancer Society mammography screening guidelines among Latinas, and found that a physician's recommendation and instructions were the biggest factors associated with adherent behavior.

Although breast cancer is the second leading cause of cancer death in non-Hispanic white women, it is the leading cause among Latina/Hispanic women in the United States.  This disparity can be attributed to later-stage diagnosis and lower mammography rates for Latinas.  A Latina participants living in Denver, Colorado were surveyed regarding sociodemographic information, breast cancer screening, and physician involvement.  The final sample size included 344 U.S.-born Latinas and immigrants over the age of 40.  Compared to U.S.-born respondents, Latina immigrants reported lower levels of educational attainment and lower rates of health insurance, household income and employment.  The authors found that compared to women who did not have mammography recommendations or self instruction by their physicians, women who had physicians recommend a mammogram were 5.1 times more likely to report adherence and women who were instructed on how to examine their breast were 3.4 times more likely report adherence.  The authors also evaluated age differences and found that older women were 1.04 times more likely to follow mammography guidelines than younger women.

The authors noted that breast cancer screening disparities were less dependent on Latina women's sociodemographic characteristics than on their physician's involvement through active breast cancer screening instructions and referrals.  The authors suggested that more research needs to be conducted to assess whether the type of insurance coverage (e.g. private versus public) influences mammography adherence.

(González P, Borrayo EA. "The Role of Physician Involvement in Latinas' Mammography Screening Adherence." Women's Health Issue. (January 2011).)

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15. Survival Following Non-Small Cell Lung Cancer Among Asian/Pacific Islander, Latina, and non-Hispanic White Women Who Have Never Smoked

A recent study from the Cancer Epidemiology, Biomarkers and Prevention journal examined survival rates among women diagnosed with lung cancer in the San Francisco are and found Asian/Pacific Islander (API) and Latinas had worse survival rates than non-Hispanic whites.

Using data from the Greater Bay Area Cancer Registry, researchers identified women diagnosed with lung cancer, and screened them via a telephone interview to determine their eligibility for the study.  This yielded 504 women who had never smoked, 472 of whom were non-Hispanic white, Latina or API.  Data, including information about the patient's sociodemographic information, neighborhood and institutional characteristics, hospital utilization, and follow-up data were obtained for 462 women.  The authors found a higher proportion of API and Latina women were never smokers compared with non-Hispanic white women, and a higher proportion of foreign-born Latinas and foreign-born APIs had no first-degree family history of cancer.  The authors also found that two-year survival rates were higher for non-Hispanic white women (56.6%) than they were for either Latinas (US born = 37.7% and foreign-born = 38.6%) or API women (US born = 39.8% and foreign-born = 47.4%).  Even after controlling for the stage of diagnosis, survival rates were better for non-Hispanic white women than they were for Latinas and API women, and mortality rates for Latinas and API women were as much as twice that of non-Hispanic white women.

The authors noted that the observed survival differences were not explained by social or clinical factors, and suggested that something else such as behavior or cultural attitudes toward the health care system may be at play.  The findings of this study are in contrast with other findings from a study using data from the southern California cancer registry, and the authors suggest the difference may be a result of gender differences and/or population differences between northern and southern California.  They conclude that more research is needed to "to identify the underlying reasons for disparities," and that there is a need for "heightened clinical awareness." 

(Gomez SL, Chang ET, Shema SH, et al.  "Survival Following Non-Small Cell Lung Cancer among Asian/Pacific Islander, Latina, and Non-Hispanic White Women Who Have Never Smoked."  Cancer Epidemiology, Biomarkers and Prevention, (January 14, 2011); doi: 10.1158/1055-9965.EPI-10-0965.)

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16. Language and Literacy Relate to Lack of Children's Dental Sealant Use

According to the findings of a study published in the journal Community Dentistry and Oral Epidemiology, regardless of race or ethnicity, the percentage of children lacking dental sealants was high, but there were significant differences by acculturation and parental health literacy.

Racial and ethnic disparities in dental caries have been well documented, and dental caries are the result of many different factors, including health behaviors, social and physical environments as well as health care.  Using data from the California Oral Health Needs Assessment 2004-2005 and a follow-up questionnaire, this study sought to quantify the percentage of third grade children in California's public schools without sealants, and to examine disparities among those lacking sealants.  Acculturation was determined by English language ability, and parent functional health literacy was measured according to the manner which the parent completed the follow-up questionnaire.  About half of the data were missing from questionnaires, as it was optional.  Missing data were imputed.  Analyses revealed that 67.1% of non-Hispanic white children were lacking sealants, but 74% each of non-Hispanic blacks, Hispanics, and Asian children lacked sealants.  Rates were higher for children who spoke a language other than English at home, and rates were higher among English language learners.  The authors also found higher rates among children of parents with lower functional health literacy.

The findings from this study indicate that few children regardless of race are obtaining dental sealants, and that children of parents with lower levels of functional health literacy and those who speak a language other than English at home are less likely to obtain them.  The authors suggest that futures studies should concentrate on understanding the barriers to sealants "both from the perspective of parents and clinicians."

(Mejia GC, Weintraub JA, Cheng NF, et al.  "Language and Literacy Relate to Lack of Children's Dental Sealant Use."  Community Dentistry and Oral Epidemiology, (December 29, 2010); doi: 10.1111/j.1600-0528.2010.00599.x.)

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17. Geographic Variation of Racial/Ethnic Disparities in Colorectal Cancer Testing Among Medicare Enrollees

A recent study from the journal Cancer examined colorectal cancer screening rates in Medicare beneficiaries in 8 states, and found racial and ethnic as well as regional disparities among those who were up-to-date with their screening.

Racial and ethnic disparities in cancer screenings are well documented and geographic variations in health and access to care among Medicare beneficiaries is also well documented.  What is not well documented is whether racial and ethnic disparities in cancer screening rates are consistent across geographic regions.  The authors undertook and analysis of individuals between the ages of 69 and 79, who resided in one of 11 US Surveillance, Epidemiology, and End Results (SEER) registries, and were included in the 2003 5% sample of Medicare enrollees to address this question.  Their analysis of 53,900 Medicare beneficiaries in 11 different locations revealed significant differences in the racial and ethnic composition of the registries as well as the prevalence of up-to-date status across and within racial and ethnic populations.  For example, 29% of black Medicare beneficiaries in San Jose, CA were up-to-date, compared with 44% of blacks in Iowa, while the gap between up-to-date rates for blacks and whites ranged from a low of -0.5 percentage points in Iowa to 16.0 percentage points in San Jose, CA.  These findings were consistent within the Hispanic and the Asian/Pacific Islander populations. 

The authors suggested that observed disparities may be the result of regional variations in "segregation within primary care practices… lower access to primary care [for minority beneficiaries]," and differential access to specialists.  The recommend future studies determine what the local and regional barriers are that prevent people of color from obtaining colorectal cancer screenings, and why their impact differs in some areas.

(Semrad TJ, Tancredi DJ, Baldwin L, et al.  "Geographic Variation of Racial/Ethnic Disparities in Colorectal Cancer Testing among Medicare Enrollees."  Cancer, (January 10, 2011); DOI: 10.1002/cncr.25668.)

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18. Health and Health Care Disparities Among Homeless Women

The authors of a recently published study in Women & Health examined data from homeless women in Los Angeles County and found racial and ethnic disparities in unmet health needs, as well as disparities in depression, drug abuse and violence.

Researchers from several departments at the University of California Los Angeles analyzed data from a sample of 1,344 homeless women which was collected for the "Decision-making Regarding Drug Use among Homeless Women" between 1994 and 1996.  The final sample included 1,331 women who self-identified as African American, Latina or white.  Nearly 80 percent of the women in the study were either African American or Latina, 56 percent of the women reported using an illegal drug and/or alcohol in the past year, and 30 percent reported being sexually assaulted as an adult.  Relative to the African American and Latina counterparts, white homeless women had higher rates of alcohol and drug problems, physical and sexual assault as adults, recent depression and bodily pain.  Homeless white women were also more likely to report an unmet health need, although Latina women were least likely to report using health care services.  Even after controlling for social factors, the white homeless women remained about twice as likely as African American women and five times as likely as Latina women to report an unmet medical need.

The findings from this study reinforce those from other studies that have demonstrated poorer health in homeless women.  Some of the findings that white women experienced more unmet health needs than women of color are contrary to other studies in racial and ethnic disparities, but consistent with studies of homeless women.  The authors conclude that their study amplifies the "need and importance of examining the unique characteristics, health and health care needs and the relationships between them according to the different racial/ethnic subgroups of homeless women."

(Teruya C, Longshore D, Andersen RM, et al. "Health and Health Care Disparities among Homeless Women." Women and Health, 50, (December 2010): 719-736.)

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DISPARITIES DATA SPOTLIGHT

SOURCE: Based on the results of a national survey conducted by the Kaiser Commission on Medicaid and the Uninsured and the Georgetown University Center for Children and Families, 2011.

In 2010, many families and states continued to face economic challenges, which resulted in an increased number of uninsured adults. Medicaid and the Children's Health Insurance Program (CHIP) continued to play a vital role, providing coverage to millions of people who would otherwise lack affordable coverage options. Findings from a survey of state officials in all 50 states and the District of Columbia regarding their Medicaid and CHIP programs found that while a few states were able to increase income eligibility for children in 2010, eligibility for their parents continued to lag far behind. The median eligibility for parents remains at 64 percent of the federal poverty level, and 16 states limit eligibility to below 50 percent of the federal poverty level.

To read more about the findings of the 50-state survey of state officials, please see Holding Steady, Looking Ahead: Annual Findings Of A 50-State Survey Of Eligibility Rules, Enrollment and Renewal Procedures, And Cost Sharing Practices in Medicaid and CHIP, 2010-2011.