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The update also summarizes recent journal articles and other research developments in the field and features a data slide from a relevant Kaiser Family Foundation publication.
1. Stress and Aggressive Breast Cancer Go Together, Study Finds DISPARITIES IN RESEARCH
8. Metropolitan-Level Racial Residential Segregation and Black-White Disparities in Hypertension DISPARITIES DATA SPOTLIGHT Barriers to Health Care Among Nonelderly Adults by Insurance Status, 2010 DISPARITIES IN THE NEWS 1. Stress and Aggressive Breast Cancer Go Together, Study Finds The study, conducted by researchers at the University of Illinois at Chicago, surveyed 989 women who had been diagnosed with breast cancer within the last three months about their stress levels. The results showed that women with higher levels of stress were 38% more likely to have estrogen receptor-negative breast cancers. For these types of cancers, medications such as Tamoxifen, raloxifene, Arimidex are not helpful. Furthermore, the findings also showed that these women were 18% more likely to have high-grade tumors, which tend to be more aggressive. The study also found that on average black and Latina women had higher stress scores than white patients. The study researchers acknowledged that it was not possible to determine if high stress levels existed prior to being diagnosed with breast cancer or if high stress levels are the result of being diagnosed with breast cancer. According to Garth Rauscher, lead researcher, “It’s not clear what’s driving this association. It may be that the level of stress in these patients’ lives influenced tumor aggressiveness. It may be that being diagnosed with a more aggressive tumor, with a more worrisome diagnosis and more stressful treatments, influenced reports of stress. It may be that both of these are playing a role in the association. We don’t know the answer to that question” (Kaplan, 9/19). 2. People Who Live in Poorer Areas May be at More Risk for Sudden Cardiac Arrest A recent article published in the Chicago Tribune discussed a recent report that found individuals who live in poorer cities have a higher frequency of sudden cardiac arrest. The report examined data from 9,235 people in seven cities, four in the U.S. and three in Canada. The researchers also examined the median household income and the relationship to sudden cardiac arrests. According to the study the article reported on, six of the seven cities demonstrated that individuals who are under 65 and live in areas of lower socioeconomic status have higher odds of sudden cardiac arrest. Furthermore, according to the article, the United States has a higher rate of sudden cardiac arrest than Canada. The study authors suggested that their results may be attributed to Canada having universal health care. According to the article, the authors in the study suggest that intervention programs are needed to help lower the risk factors that these individuals are exposed to as well as providing training for cardiopulmonary resuscitation (Stein, 9/13). 3. Reduced State Dental Benefits Create Dire Situation for Patients In the wake of California’s cuts to dental benefits to the Medi-Cal program, a recent article published in The Los Angeles Times discussed the realities that patients may face who rely on this program to receive dental treatment. According to the article, roughly 3 million Medi-Cal recipients faced a sharp reduction in dental benefit treatments. The Medi-Cal program now only covers necessary extractions for adults. As a result, the article makes aware that patients may wait till dire moments to receive dental treatment. Furthermore, because there coverage only allows them the recommended extraction, patients are having teeth pulled but not having their teeth repaired or replaced. According to the article, this places them at risk of contracting gum disease while affecting their appearance and odds of finding a job. The issue of dental health, according to some experts cited in the article, do not just rest with dentist. Frederick P. Rivara, a Seattle pediatrician who chaired the committee that wrote the report, said “Oral health isn’t just the responsibility of dentist.” “There is a real need to have other healthcare providers involved,” Rivara continued. The article also cited a report that was released in July by The Institute of Medicine (IOM). The IOM recommended states to include dental coverage for adults with Medicaid while also recommending better training for doctors in primary care to spot oral diseases. Venice Family Clinic is attempting to meet these needs by opening a new dental service for patients and training its pediatricians to do initial screening and care to spot oral diseases before they progress (Gorman, 9/12). 4. Lower-Income Northern Virginians Struggle to Get Dental Care, Report Finds A recent article published in The Washington Post discussed a report that claims many lower-income adults who live in one of the most prosperous areas in the United States have not seen a dentist in the past five years. According to the report cited in the article, 16 percent of lower-income adults have not seen a dentist in the past five years. Furthermore, only one out of four lower-income adults have dental insurance coverage, compared to 64% of higher-income adults. The article mentions that Northern Virginia has an image of being one of the wealthiest areas in the US with a median household income above $100,000. According to the report, individuals were considered lower-income if their annual salary was $40,000 or less. This baseline was based off of the 2009 Census data, where it showed that there are 1.5 million adults who earn more than $40,000 in Northern Virginia. Patricia Mathews, president of the Northern Virginia Health Foundation, said “For people with limited means and no insurance, routine dental care is often out of reach.” According to the article, Medicaid in Virginia only covers necessary oral surgery but no regular checkups or root canals. There are very few safety-net organizations that provide dental care, like Northern Virginia Dental Clinic Loudoun, and many of them have long waiting lists. According to the article, poor oral health has a significant relationship to poor health conditions like heart disease, diabetes, and stroke. Furthermore, it makes the employment process that much harder to attain for these individuals (Sun, 9/08). 5. Minority Organ Donations Insufficient to Meet Transplant Need A recent article published in the Pittsburgh Tribune-Review discussed the major shortages of minority organ donors compared to the high amount of minority citizens needing organ transplants. According to the National Minority Organ and Tissue Transplant Education Program, which was cited in the article, minorities make up half of all people on the transplant waiting list, however, only 25% of transplant donors are minorities. Lisa Upsher, program director of the Center for Organ Recovery and Education (CORE), said “In minority communities, there is a high risk of diabetes, hypertension, and certain genetic disorders that often cause people to need transplants. But there is strong resistance to being an organ donor—for a number of reasons.” The article mentions that one of the reasons stems from the relationship of mistrust between the medical community and minority communities. One such example of this mistrust can stem back to the Tuskegee experiment, where several men were injected with the life threatening sexual transmitted disease, syphilis, and left untreated by the U.S. Public Health Service. Other reasons stem from community awareness about renal disease and transplantation, religious beliefs, or superstitions according to the National Minority Organ and Tissue Transplant Education Program. Angela Ford, executive director of the University of Pittsburgh Center for Minority Health, said “That study, even four decades later, has done a lot to undermine medicine. It also still really hurts the ability to recruit African Americans into any medical research project.” The article points out how important it is for every person, especially minorities, to become an organ donor because more than 16 people die each day waiting for an organ transplant while 83,000 people are on the national transplant waiting list (Wills, 9/04). 6. Report Shows Central Minnesota Has Highest Diabetes, Stroke, Mortality Rates A recent article published in the St. Cloud Times discussed that people who live in central Minnesota have the highest diabetes, stroke, pneumonia, and influenza mortality rates in the State. The article reports on the findings from the Minnesota Department of Health’s report, which examined the health of people living in rural Minnesota. According to the report, the central region, which includes Benton, Chisago, Isanti, Kanabec, Kandiyohi, McLeod, Meeker, Mile Lacs, Pine, Renville, Sherburne, Stearns and Wright counties, have the highest hospitalization rates for asthma, emergency department visits, highest rates of death from pneumonia and influenza, and highest prostate cancer incidence rate. The report mentioned that “This reports is intended to generate awareness among policymakers, primary and rural health care providers, public health officials and concerned community members about the importance of examining rural and regional disparities.” Dr. Chirstopher Wenner, a family physician in Cold Spring and president of the Stearns Benton Medical Society, said “It’s surprising to me.” Dr. Wenner continued “I don’t see Central Minnesota as being a significantly depressed medical area.” According to the article, this report is a follow-up to “Health and Well-being of Rural Minnesotans: A Minnesota Rural Health Status Report.” For those who are interested about more information regarding this report, visit the Minnesota Department of Health website at www.health.state.mn.us/divs.orhpc/pubs/workforce/status.pdf (Lee, 9/03). 7. How One Florida County Reduces Its Homeless and Jail Populations Simultaneously A recent article published in the Governing discussed a county in southern Florida who has taken on initiatives to reduce its 30 percent jump in the homeless population and criminal incarceration. Currently, States around the Country, like Florida, have been making significant budget cuts. According to the article, these cuts exacerbate the underlying chronic issues concerning homelessness and the high incarceration rate of those who are homeless. Currently, Florida ranks 49th in per capita spending on mental health care and 35th in substance abuse care, which both mental health issues and substance abuse are some of the dominating reasons why people who are homeless being incarcerated according to the article. In light of this fact, The Bob Janes Triage Center and Low Demand Shelter in Lee County, Florida created a program that helps reduce costs to tax-payers for jailing homeless citizens and provides the services these individuals actually need. These shelters, unlike other shelters, allow police officers, hospitals, and the state Department of Veterans Affairs to refer homeless individuals to these centers. The triage center offers mental health and substance abuse services, food, overnight and daytime stay, and a program to help individuals target goals that will help them get off the streets. Ann Arnall, director of Lee County Human Services, says “there’s the door,” if clients refuse to meet with case workers and make goals to improve their lifestyle. According to the article, participants are free to stay if they are making progress towards their goals. “If you understand recovery from a mental illness or substance abuse disorder, not everybody gets it the first time,” says Arnall. However, Florida’s Governor, Rick Scott, vetoed a $250,000 earmark for the triage center, which would have accounted for 20 percent of the center’s operational costs. This cut placed the center in a tight budget squeeze and Arnall stresses that this could affect the center’s entire mission. “If we don’t have those services, then we become an ineffective holding place” (Cournoyer, 9/00). DISPARITIES IN RESEARCH 8. Metropolitan-Level Racial Residential Segregation and Black-White Disparities in Hypertension According to an article published in The New York Times, Michael Bloomberg, the Mayor of New York, plans to use $30 million from his foundation to help fund a program aimed at reducing economic and educational disparities among the City's young black and Latino men. The article noted there are approximately 315,000 black and Latino people in New York City, and they are disproportionately undereducated, incarcerated and unemployed. Mayor Bloomberg plans to implement a $130 million program to improve the educational and economic life of these underserved New York residents. He will be providing $30 million of his own money from his foundation, and will receive a matching contribution from George Soros. The money will be used to put job-recruitment centers in public-housing complexes, retrain probation officers to help reduce recidivism, establish new fatherhood classes, and assess schools on academic progress. For the first time, school assessments will include a measurement of how well black and Latino males are progressing. The program will also include a mentoring program and will implement ways to help black and Latino individuals obtain a driver’s license or state identification card. Andrea Batista Schelsinger, a special adviser to the mayor, said having proper identification is one of the major barriers black and Latino populations face when searching for a job. “They didn’t know why they should have it or how to get it,” said Schelsinger. Although these efforts are encouraging, there are some skeptics. “The success rate, in general, is not that promising,” said Elijah Anderson, a professor of sociology at Yale. “Companies have to be much more receptive to these young people and meet people like Bloomberg halfway.” Professor Anderson is referring to the challenge of businesses hiring these people permanently after the program has ended (Barbaro 8/03). 9. Improvement of Racial Disparities With Respect to the Utilization of Minimally Invasive Radical Prostatectomy in the United States A recent study published in Cancer found the treatment of minimally invasive radical prostatectomy (MIRP) has improved among black patients; however, some disparities still persist. The researchers in this study wanted to explore the difference in MIRP rates between black and white patients. The researchers analyzed the Nationwide Inpatient Sample (NIS) discharge records in order to carry out this study. The total population the records provided was over 89 thousand patients, however, only 3,581 patients did not have missing information and were qualified for the study. The qualification for inclusion meant the patient had to be classified as having undergone MIRP using the minimally invasive modifier code (ICD-9-CM54.21). The study classified race under African-American, Caucasian, and other. The researchers only compared the data between African-American and Caucasian patients. The study’s results showed black patients were on average younger when receiving such treatment; less likely to have a Charlson Comorbidity Index (CCI) of 0, less likely to be treated at a high AHC institution, less likely to have private insurance, and less likely to be in the 4th quartile of median zip code income. Furthermore, blacks were 14% less likely than white patients to undergo MIRP. The researchers stratified the data between 2001 – 2005 and 2006 – 2007 because in the year of 2006 because the utilization rate became virtually equal. However, from 2001 to 2007, black patients were 22% less likely than white patients to undergo MIRP. However, that rate dropped to 11% in the latter years. The researchers suggest that this data demonstrates improvement in this type of services for black men; however, still point out that disparities in treatment still exists. The researchers provide a few explanations as to why based on earlier research done in this area. For example, access to care, while it has improved, still is a major impediment among black men receiving this type of care. (Trinh QD, Schmitges J, Sun M, et al. Improvement of racial disparities with respect to the utilization of minimally invasive radical prostatectomy in the United States. Cancer. 2011 Sep; DOI: 10.1002/cncr.26527) 10. The Neighborhood Contribution to Black-White Perinatal Disparities: An Example from Two North Carolina Counties A recent study published in the American Journal of Epidemiology found significant disparities for black women in perinatal outcomes in comparison to white woman on the basis of where the women live. The researchers in this study wanted to explore the observed and unobserved inequalities that a neighborhood contributes to the birth outcome disparity among black and white women. The researchers explored three areas in perinatal outcomes; low-birth weight (LBW), preterm birth (PTB), and small gestational age (SGA). Relying on birth certificate records for Durham and Wake counties in North Carolina, the researchers analyzed a total of 31,489 records. 21,221 white women and 10,268 were black women. They used a neighborhood deprivation index, composed of several sociodemographic domains, which was used to as an indicator of the socioeconomic status of the two counties. The study’s findings demonstrated clear disparities between the two counties, where black women were twice as likely to deliver LBW, PTB, and SGA infants compared to white women. The highest correlation between perinatal outcomes and the contribution that possible factors a neighborhood may have in this disparity was noticed in preterm birth (15% difference between black and white women). The researchers argue that the results demonstrated a clear disparity among black and white women due to the factors one may face living in a particular neighborhood. Furthermore, the researchers argue that integration could possibly reduce these disparities. However, further research will need to examine further areas of social determinants that may be influencing such disparities, such as income and access to care. (Schempf AH, Kaufman JS, Messer LC, et al. The neighborhood contribution to black-white perinatal disparities: an example from two North Carolina counties, 1999-2001. American Journal of Epidemiology. 2011 Sep; 174(6):744 -752). 11. Physical and Mental Health Disparities among Young Children of Asian Immigrants A recent study published in The Journal of Pediatrics found significant disparities in the physical and mental health of children of foreign born Asian immigrants compared to U.S. born white and Asian children. The researchers in this study wanted to explore what are some of the disparities linked to those children of Asian descent. Specifically, the researchers wanted to explore possible disparities on a host of areas among children that included their physical and mental health, areas of financial capitol, social capitol, and areas that concerned the home. The researchers relied on the 1998 – 1999 Early Childhood Longitudinal Study-Kindergarten Class (ECLS-K) base-year public use data file. The total number of families they wanted to interview that were of Asian ancestery was 748. They used non-Hispanic white families as their reference group. The researchers also wanted to explore differences within the Asian population. In order to do this, they stratified the Asian population into five sub-groups based on the children’s parents of origin: east Asian (China/Hong Kong, Japan, Korea, and Taiwan), southeast Asian (Burma, Cambodia, Indonesia, Laos, Malaysia, Philippines, Thailand, and Vietnam), south Asian (Bangladesh, India, Nepal, Pakistan, Sri Lanka, and Afghanistan. They also took into account mixed Asian parents, where either 1 parent is from an Asian country or both parents are from Asian descent, however, they are from different countries. Finally, they took into account U.S. born Asians, where the parents were born in the United States. The researchers measured the children based on if their health status was poor/fair or excellent/very good, overweight or not overweight, whether they have self-control, interpersonal relationship skills, externalizing problems, internalizing problems, living or not living in poverty, household composition (2-parent home, number of siblings, number of people living in the household), the parents well-being (depression), neighborhood safety, parental education, home environment (based on how many books are available to the children), and child care arrangement. The results showed that Asian families were more likely to be poor and use social services, and were likely to live in unsafe neighborhoods. These results primarily showed in south and southeastern Asian groups. Furthermore, Asian children experienced bad physical health and fewer interpersonal relationship skills. The results did show that children of U.S. born Asians did not differ from non-Hispanic whites. The researchers suggest considering the context of a children’s health and background is vital. Furthermore, the researchers argue that the data refutes the notion that Asians are the “model minority,” a group of minority citizens who are not disproportionately affected by social determinants. (Huang KY, Calzada E, Cheng S, et al. Physical and mental health disparities among young children of Asian immigrants. The Journal of Pediatrics. 2011 Sep; doi:10.1016/j.jpeds.2011.08.005). 12. Understanding Racial and Ethnic Disparities in U.S. Infant Mortality Rates A recent report by the National Center for Health Statistics found infant mortality rates for black, American Indian/Alaska Native, and Puerto Rican woman have all increased over time. The recent report explored the infant mortality rate among different racial and ethnic women in the United States. The report revealed significant disparities among some racial and ethnic groups when compared to non-Hispanic white women. For example, the infant mortality rate for black women was 13.31 infant deaths per 1,000 live births in 2007. The figure is 2.4 times the rate for white women (5.63). The report further demonstrated those disparities along the lines of preterm births, very preterm births, and infant mortality rates for sudden infant death syndrome (SIDS). For example, nearly one out of five births from a black mother resulted in a preterm birth (18.3%) and very preterm births were 4.1 percent, two times the percentage of white women. The disparity also can be seen in Puerto Rican women, with infant mortality rates for preterm-related causes was 71 percent higher than white women. Although the report significant disparities between some minority women in comparison to white women, not all minority women had higher rates of infant mortality causes. According to the findings of the report, Asian and Other Pacific Islander women had some of the lowest rates of infant mortality. (MacDorman MF and Mathews TJ. Understanding racial and ethnic disparities in U.S. infant mortality rates. National Center for Health Statistics. 2011 Sep; data brief 74). 13. Neighborhood Socioeconomic Status and Influenza Hospitalizations Among Children: New Haven County, Connecticut, 2003 – 2010 A recent study published in American Journal of Public Health found a significant association between impoverished or crowded neighborhoods and influenza-associated hospitalization among children in New Haven County, Connecticut. The researchers in this study wanted to explore the potential disparities in pediatric influenza-associated hospitalizations among children living in New Haven County. Relying on the 2003 – 2010 population-based surveillance data from the Connecticut Emerging Infections Program and the SES data from the U.S. census 2000 Summary File 3, the researchers explored how much impoverished and crowded neighborhoods have a correlation with influenza hospitalization. 64.6% of the total study population was white, while 14.5% was black and 15.7% was Hispanic or Latino. The study’s findings demonstrated that there were 527 cases of influenza-associated hospitalizations among children in New Haven County. The findings also demonstrated that the rates of influenza-associated hospitalization for children younger than 5 was 4 times higher than older age groups. Although the rates did not differ significantly on the basis of gender, the results did differ on the basis of race/ethnicity. In fact, for black and Hispanic children the rates of hospitalization were 3.4 and 3.0 times higher, respectively, than white children. The findings also demonstrated that the rates increased as the poverty and crowding levels increased. The researchers suggest that these findings help understand influenza-associated hospitalization disparities and how to eliminate them. They suggest that more coordinated efforts coupled with targeted programs towards children who live in high poverty and crowded areas are needed to lower this disparity. (Yousey-Hindes KM, and Hadler JL. Neighborhood socioeconomic status and influenza hospitalizations among children: New Haven County, Connecticut, 2003 – 2010. American Journal of Public Health. 2011 Sep; 101(9): 1785- 1789). 14. The Demographic, System, and Psychosocial Origins of Mammographic Screening Disparities: Prediction of Initiation Versus Maintenance Screening Among Immigrant and Non-immigrant Women A recent study published in the Journal of Immigrant Minority Health explored differences in mammographic screening disparities among immigrant born citizens based on a number of factors and found among women in different sub-populations either had no screening or very low screening in the past ten years. The researchers in this study wanted to explore the screening patterns among women in ethnic sub-populations based on demographic, healthcare/health, and psychosocial predictors. They analyzed 1,364 women (50 – 70 years of age) living in Brooklyn, New York. The researchers used the Household Income and Race summary Tape File 3a of 1990 census files to stratify the participants into sub-populations. The participants were either US born African Americans, Caribbean immigrant women (Haiti, Dominican Republic, or other English speaking territories), US born European Americans and Eastern European women from the former USSR (Russia, Ukraine, and Belarus). US born and immigrant European’s were the comparison group. The researchers in the study found disparities among women in different sub-populations. For example, Haitian women were more likely to have never screened or sub-optimal screen (have screened, but not at the recommended levels) than any other group. The data suggests, according to the researchers, that women of different ethnic sub-populations are less likely to have a consistent pattern of screening compared to US born white Americans. Another interesting finding from the study showed Haitian women were more likely than any other group to have never screened; however, were less likely to have a screen yearly than US born black and white Americans. The researchers suggest that the data provides sufficient reasons why examining different characteristics among specific groups are important for breast cancer screening. (Consedine NS. The demographic, system, and psychosocial origins of mammographic screening disparities: prediction of initiation versus maintenance screening among immigrant and non-immigrant women. Journal of Immigrant Minority Health. 2011 Sep; DOI 10.1007/s10903-011-9524-z).
A recent report from the Census Bureau estimates there were 49.9 million uninsured people during 2010. Five Facts About the Uninsured, from the Kaiser Family Foundation, discussed why so many people lack coverage and the implications being uninsured can have on an individual’s health and access to care. One in four uninsured adults has forgone needed health care in the past year due to cost. Relative to individuals with insurance, the uninsured receive fewer recommended screenings and less preventive care, the results of this puts them at a higher risk for preventable hospitalizations and for missed diagnoses of serious health conditions, and the uninsured have significantly higher mortality rates than those with insurance. Even after being diagnosed with a chronic condition, the uninsured are less likely to receive follow-up care. To learn more about the uninsured and their access to care, please read Five Facts About the Uninsured.
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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. 
