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 This free, monthly update synthesizes news coverage from hundreds of print and broadcast news sources related to health and health care issues affecting underserved and racial and ethnic communities.
The update also summarizes recent journal articles and other research developments in the field and features a data slide from a relevant Kaiser Family Foundation publication.
1. Assault: Children With Disabilities Are More Likely To Be Victims Of Violence, Analysis Shows
A recent article published in the New York Times discussed a study commissioned by the World Health Organization (WHO) that found children with disabilities are nearly four times more likely to be physically assaulted than the general population of children.
The report, published in the Lancet, showed that children with disabilities are 3.6 times more likely to be physically assaulted and 2.9 times more likely to be sexually assaulted than other children. The study found that the most common victims of sexual assault were children with mental illness or retardation. Furthermore, institutionalized children were more likely to be attacked than those living at home. The report was a meta-analysis of 17 other studies that included evidence on more than 18,000 children from wealthy countries worldwide, including the United States.
Dr. Etienne Krug, director of the department of violence and injury prevention within WHO, said that additional studies on strategies that are proven to protect other children should be undertaken for the disabled (McNeil, 07/16).
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2. Imperial County Leads State In Treatment Of Children With Asthma
A recent article published in the Los Angeles Times discussed how children in Imperial County, California, have the highest rates of asthma-related emergency room admissions in the state.
Children in the county are admitted into the emergency room or hospitalized at a rate three times higher than the state average. Imperial County is approximately 4,600 square miles, mostly desert, and just north of Mexico and west of Arizona. The majority of the county is rural, and 20 percent of the population lives in poverty. Furthermore, the county air quality is poor, which is largely attributable to unpaved roads, agricultural tilling, and industrial pollution from Mexico. According to the article, one in five children ages five to 17 in Imperial County has been diagnosed with chronic respiratory disease. At one of the county's junior high schools, the principal regularly cancels outdoor activities and sends air quality alerts to school staff. Meredith Milet, an epidemiologist with the state Department of Public Health, said, “There is obviously a disparity. ... There is just a need for something to change. It should be possible for it to be different for the kids of Imperial.” Kids are often admitted to the emergency room from other asthma triggers, including cigarette smoke, mold or pets, and sometimes they do not know how to manage their disease, said Luz Tristan, a physician in Calexico.
The prevalence of asthma in California is a major problem, according to the article. For example, the Central Valley cities of Fresno, Merced, and Bakersfield, which are heavily agricultural, are some of the worst cities for asthmatics in the nation. However, Imperial County stands out for its emergency room admission rate (Gorman, 07/16).
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3. HEALTHBEAT: AIDS Turning Point? Experts To Meet This Month Amid Optimism For HIV Prevention
A recent article published by the Associated Press discussed efforts to end HIV/AIDS in the United States and around the world.
More than 20,000 international HIV researchers and activists convened in Washington, D.C., July 22-27 for the XIX International AIDS Conference. In the U.S., HIV is increasingly affecting poor, minority, and urban communities, including the District of Columbia, where the HIV prevalence rate rivals that in some developing countries. HIV/AIDS disproportionately affects gay and bisexual men as well as racial and ethnic minorities, particularly blacks. Studies have largely demonstrated that treating people living with HIV earlier reduces the likelihood of transmission to uninfected sexual partners and increases their chances of living healthy lives, the article notes. However, a challenge facing the HIV/AIDS fight is perception. “We’ve become complacent about HIV in America, and it’s a real tragedy because hundreds of thousands of people in our own country aren’t getting the care they need,” said Chris Collins of amfAR, The Foundation for AIDS Research. A poll conducted by the Associated Press and GfK Roper Public Affairs and Corporate Communications found less than 20 percent of Americans are worried about contracting HIV, including populations that are at the highest risk of HIV infection. For instance, blacks make up 14 percent of the American population but account for 44 percent of new HIV infections, and only 16 percent of black survey respondents said they are very worried about HIV.
Despite these high rates, those in the HIV/AIDS research community have a sense of optimism, the article notes. Dr. Anthony Fauci, head of the National Institutes of Health's infectious diseases division, said, “I think we are at a turning point.” He added that “studies over the past two years have shown striking, sometimes breathtaking results, in preventing people at high risk of HIV from getting it in some of the hardest hit countries, using this treatment-as-prevention and some other protections” (Neergaard, 07/09).
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4. To Understand MH Disparities, Look To R.I.C.E., Not Race
A recent article published by Psychiatric News highlighted the complex influence of race, immigration, culture, and ethnicity, or “R.I.C.E.,” on disparities in mental health.
According to the article, the construct of “race” often is used to capture a vague set of biological and social forces. Based on his research, Dr. James Jackson, professor of psychology and director of the Institute for Social Research at the University of Michigan, noted, “Race matters even if we don’t know what race is.” Jackson studied blacks of Afro-Caribbean descent to better understand the interplay between race, ethnicity, and immigration status. Surveys in both the United States and Great Britain indicate that ancestry, gender, timing of immigration, and age at immigration all influenced the prevalence of mood disorders. Aggregated 2004 data from the National Survey of American Life revealed that 19.9 percent of whites reported a mood disorder in their lifetime, compared to 12.5 percent of blacks, and 13.7 percent of Afro-Caribbean respondents. However, more nuanced analysis revealed variation based on immigration status. The rate of lifetime mood disorder was 24.3 percent for Afro-Caribbean respondents whose parents had been born in the United States, compared to 6.3 percent for respondents who had immigrated 11 to 12 years before the survey. The study also revealed variations in the prevalence or severity of mental health disorder associated with gender, ethnicity, and country of origin.
According to Jackson, “There’s no simple story. … [D]ifferences in psychopathology are not reducible in any simplistic way to differences in social and economic statuses among groups” (Levin, 07/06).
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5. Feds Rank Texas Worst Healthcare Provider
A recent article published in the Houston Chronicle discussed how Texas ranked last for health care delivery in the recent annual rankings report by the federal Agency for Healthcare Research and Quality (AHRQ).
Texas was ranked 51st on overall health rankings in the report, which is behind every state and the District of Columbia. Texas scored a 31.61 out of a possible 100 points in AHRQ’s annual rankings report. Currently, Texas has the highest uninsured population in the nation (25 percent) and has a poor delivery of care system in different settings and clinical areas, according to the report. Ernest Moy, AHRQ’s medical officer and lead author of the scorecard, said, “We’re not comparing it to some fantasy world, we’re comparing it to other states around the nation.” Other states that ranked above Texas but near the bottom were West Virginia, Arkansas, Oklahoma, and New Mexico. Stephanie Goodman, spokesperson for the Texas Health and Human Services Commission, said that “the report card includes services far beyond our state Medicaid program, but it does reinforce the need for improving access to preventive services.” Texas also ranked the lowest for quality of care for breast cancer patients younger than 70 years of age and scored worst for in-home health care among patients with respiratory problems, urinary incontinence, and chronic pain.
The article notes that Texas ranked above the national average in the quality of care provided to Hispanics and blacks as compared to whites. In addition, Texas ranked average in mortality rates and avoidable complications among privately insured people (Ackerman/Walczak, 07/05).
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6. Site Of Care Linked To Racial Imaging Disparities In Stroke
A recent article published by MedWire News discussed a study that found stroke patients were less likely to undergo carotid artery imaging when they were treated at hospitals with a high proportion of minority patients.
According to recent research, patients of all racial and ethnic backgrounds experienced disparities in stroke care when treated in hospitals serving a high proportion of minorities. The study, published in Neurology, examined the treatment of black and white stroke patients admitted to 127 Veterans Affairs Medical Centers in 2007. In the hospitals in the top 10 percent of minority stroke admissions, 78 percent of white patients and 71 percent of black patients received carotid artery imaging. In comparison, 90 percent of white patients and 87 percent of black patients treated in the other hospitals received carotid artery imaging. According to the researchers, these disparities “were driven by differential use of carotid ultrasound, an older, more inexpensive, and more universally available technology,” not by lower rates of advanced imaging technology use at the hospitals serving a higher proportion of minorities. In a related editorial, Richard Benson and Jason Freeman of Washington Hospital Center in Washington, D.C., said, “This study is vitally important because it illustrates a potentially modifiable health systems factor which affects not only one race of patients but all patients treated at certain facilities.”
The researchers concluded that the effect of available hospital resources remains unknown. Benson and Freeman noted it is “possible that minority-serving hospitals have fewer resources and are unable to afford appropriate equipment or technicians to perform [carotid artery imaging]” (McDermid, 07/02).
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DISPARITIES IN RESEARCH
7. Unmet Eye Care Needs Among U.S. 5th-Grade Students
A recent study published in the American Journal of Preventive Medicine found one in eight surveyed parents could not afford to purchase new or replacement eyeglasses for their children who were told they needed eyeglasses.
Vision loss caused by refractive errors is among the most prevalent disabling condition among U.S. children. Prior studies have associated uncorrected refractive error with the development of behavioral problems and poor social interaction, the authors noted. The current study is the first large-scale and multi-state study to estimate prevalence and risk factors for two types of unmet eye care needs among 5th-grade students, affordability and insurance coverage. The researchers used survey data from parents and non-parent primary caregivers in Birmingham, AL, Houston, TX, and Los Angeles, CA, who participated in the Healthy Passages longitudinal study between fall of 2004 and summer 2006. The sample included 1,794 children who already wore eyeglasses or were told they needed eyeglasses from a medical representative. Covariates included age, race, gender, education, income, marital status, and type of insurance coverage. The findings revealed 13.7 percent of children who wore eyeglasses or were told they needed eyeglasses were unable to afford them. Among those children with health insurance, 15.1 percent reported having no vision coverage for eye examinations and eyeglasses. After controlling for some covariates, 17.6 percent of parents with incomes lower than $15,000/year reported not being able to afford eyeglasses versus 2.7 percent of those with incomes higher than $70,000/year. Parents without health insurance were more likely to report not being able to afford eyeglasses for their children (22.5 percent) than those with health insurance through a private insurer (12.5 percent), Medicaid (10.9 percent), or State Children Health Insurance Program (SCHIP) (9.6 percent). The authors concluded that socioeconomic status and health insurance status are strongly associated with parents’ ability to meet 5th-grade students’ eye care needs. The authors noted that health insurance coverage by Medicaid or SCHIP does not guarantee affordability because vision coverage varies by state; however, all new health insurance plans participating in the state-based exchanges will require vision coverage for children beginning in 2014.
The authors noted that the current study did not account for the recent economic downturn; they argue the situation of unmet eye care needs among children may be worse than the reported data in this study. Policies that provide accessible and affordable eye care to low-income families and groups may need to be adopted to address the issue.
(Zhang X, Elliot MN, Saaddine JB, et al. Unmet eye care needs among U.S. 5th-grade students. American Journal of Preventive Medicine. 2012 Jul; 43(1): 55—58).
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8. Racial Residential Segregation And Rates Of Gonorrhea In The United States, 2003—2007
A recent study published in the American Journal of Public Health found racial segregation, primarily isolation and unevenness among black populations, to be significantly associated with higher rates of gonorrhea.
No prior studies have published empirical evidence associating racial residential segregation with risk of sexual transmitted infections, the authors noted. The study aimed to explore a possible association by examining the rates within black populations residing in metropolitan statistical areas (MSAs). The authors used five consecutive years (2003-2007) of gonorrhea surveillance data reported for all MSAs in the United States. Data was gathered from the Statistics and Data Management Branch, Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the Centers for Disease Control and Prevention. MSAs were defined by using the U.S. Census Bureau census tract. The authors measured racial residential segregation with definable indexes, including: isolation, relative concentration, absolute centralization, clustering, or unevenness. Additional covariates included geographic region, population size and density, racial composition, income, gender, and education. Of the 817,531 gonorrhea cases among blacks in 257 MSAs across the U.S., the average five-year gonorrhea rate was 502.1 per 100,000. The findings demonstrated high levels of concentration and centralization, moderate levels of unevenness, and low levels of isolation and clustering. The results indicated higher levels of gonorrhea rates among blacks in isolation and in unevenly segregated areas. Isolation also was significantly associated with gonorrhea rates in all age groups, with the highest rates among those 19 years and younger and those aged 20 to 34 years. The authors argued that individuals tend to choose sexual partners in areas in which they live, and as a result infected persons in isolated areas increase the likelihood that others in the area might become infected.
This is the first study to use national data to assess the association of racial residential segregation with sexually transmitted disease risk, with a focus on gonorrhea rates, the authors noted. They concluded that future studies should investigate whether racial segregation is a contributing factor to the disparity in gonorrhea rates.
(Biello KB, Kershaw T, Nelson R, et al. Racial residential segregation and rates of gonorrhea in the United States, 2003—2007. American Journal of Public Health. 2012 Jul; 102(7): 1370—1377).
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9. Massachusetts Reform And Disparities In Inpatient Care Utilization
A recent study published in Medical Care found that the 2006 Massachusetts health reform was associated with increased utilization of inpatient care among non-elderly low- and medium-income populations and Hispanics.
Massachusetts health reform resulted in near universal health insurance coverage within the state. The authors of this study sought to understand the impact health reform had on health care utilization, particularly among the poor and minority populations expected to benefit from the legislation. The study used discharge data from in-state hospitalizations from 2004 to 2009 for 1,188 patients (non-elderly adults aged 40-64 and elderly adults aged 70-84) who received one of 17 surgical procedures most commonly initiated through outpatient physician referral. The sample was stratified by race and ethnicity (Hispanic, non-Hispanic white and non-Hispanic black) as well as by the median income of their residential zip code (areas of low, medium, and high income). The outcome variable of interest was the procedure rate for each of these cohorts. The researchers looked at the utilization rates for all high referral rate (HRR) procedures before and after health reform. The study found that post-reform procedure rates increased more for patients from low- and medium-income zip codes, compared to patients from high-income communities. Post-reform procedure rates also increased more for Hispanics and blacks compared to white patients in the sample. These findings are consistent with previous research indicating that expanded insurance coverage is associated with increased utilization of care by vulnerable populations.
The authors concluded that these findings suggest that Massachusetts health reform resulted in increased access to inpatient care for some vulnerable populations. Additional research is needed to distinguish the appropriate use of clinical services from overuse. Additional research also is needed to generalize the implication of these findings beyond Massachusetts.
(Hanchate AD, Lasser KE, Kapoor A, et al. Massachusetts reform and disparities in inpatient care utilization. Medical Care. 2012 Jul 50(7): 569—577).
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10. Age At Menarche And Risk Of Type 2 Diabetes Among African-American And White Women in the Atherosclerosis Risk In Communities (ARIC) Study
A recent study published in Diabetologia found racial differences in the association between age at first menstrual cycle and development of type 2 diabetes, when obesity was taken into account.
According to the study, while the average age of menarche (first menstrual cycle) is declining, diabetes and obesity rates are rising. Previous literature has suggested that women who have their first menstrual cycles early are at an increased risk of developing type 2 diabetes. However, the literature had not discerned the extent to which obesity may play a role in increasing the risk of diabetes and these findings also had not been generalized to non-white populations. The study examined racial differences in the association between age at menarche and type 2 diabetes. The study also sought to understand the impact of obesity on this analysis. The researchers used data from the Atherosclerosis Risk in Communities (ARIC) study to sample 8,491 white and black women from four American cities over a nine-year period. During the baseline assessment, the ARIC study gathered self-reported data on age at first menstrual period. Blood glucose measurements were used to identify women with type 2 diabetes at the start of the study and during follow-up surveys. To avoid capturing women with type 1 diabetes, participants whose self-reported diabetes diagnosis occurred before age 30 were excluded from the sample. The study found that the average of menarche (12.9) was the same across racial groups. Among white women, the prevalence of diabetes varied significantly by age at menarche. Early menarche (at 8-11 years of age) among white women was associated with a 72 percent increase in the odds of diabetes at the start of the study, compared to menarche at age 13. Among black women, the study found that menarche at age 14 (compared to age 13) was associated with 35 percent lower odds for diabetes at the start of the study. The findings for white women are consistent with previous research.
The authors concluded that racial differences in the physical development of white and black women might contribute to the later development of type 2 diabetes. In addition, the authors indicate that the course of type 2 diabetes may be different for black women; early menarche may not be a risk factor. Additional research is needed to determine if racial or ethnic differences in average age at menarche have diminished over time.
(Dreyfus JG, Lutsey PL, Huxley R, et al. Age at menarche and risk of type 2 diabetes among African-American and white women in the Atherosclerosis Risk in Communities (ARIC) study. Diabetologia. 2012 Jul; DOI 10.1007/s00125-012-2616-z).
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11. Racial And Ethnic Disparities In Preconception Risk Factors And Preconception Care
A recent study published in the Journal of Women’s Health found that American Indian and Alaska Native women were most likely to have two or more risk factors for adverse pregnancy outcomes.
Persistent racial and ethnic disparities in infant mortality rates have brought increased attention to the delivery of preconception counseling and care. By improving maternal health before pregnancy, many public health practitioners hope to reduce the rates of known preconception risk factors: at-risk drinking, smoking, obesity, diabetes, and frequent mental distress. This study aimed to understand the prevalence of these five risk factors in women aged 18-44 across demographic groups (age, race, ethnicity, educational attainment, current employment status, marital status, and social and emotional support). Using national data from the 2008 Behavioral Risk Factor Surveillance System on non-pregnant women, the authors created a sample of 54,612 women. The study found that 18.7 percent of respondents reported two or more risk factors, 33.3 percent of respondents reported one risk factor, and 48 percent reported no risk factors. Obesity was the most common risk factor and diabetes was the least common among women in the sample. American Indian and Alaska Native women were the most likely to have multiple risk factors, followed by black women. Unmarried status, lower levels of educational attainment, low levels of social and emotional support, and job insecurity (unable to work or unemployed) were all associated with having multiple risk factors. As no comparable studies exist, the authors indicated that this report makes an important contribution to the literature.
According to the researchers, the prevalence of multiple risk factors highlights a need for preconception care, which would help women increase their odds of a healthy pregnancy earlier in the family planning process. Additional research is needed to better understand the risk factors and needs of women within racial and ethnic groups. In particular, the authors highlighted the diversity of the Asian population. Although Asians (on average) had the lowest prevalence, additional research is needed to examine the risk factors among Asian subgroups.
(Denny CH, Floyd RL, Green PP, et al. Racial and ethnic disparities in preconception risk factors and preconception care. Journal of Women’s Health. 2012 Jul; 21(7): 720—729).
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DISPARITIES DATA SPOTLIGHT
Rates Of New US HIV Diagnoses Vary Significantly By Race And Ethnicity
Source: Visualizing Health Policy – HIV/AIDS: The State of the Epidemic After 3 Decades, JAMA, July 25, 2012 – Vol 308, No. 4, p. 330, Available online at http://jama.jamanetwork.com/article.aspx?articleid=1221707.
About 1.2 million people are living with HIV in the U.S. today. Racial and ethnic minorities have been disproportionately affected by HIV/AIDS and represent the majority of new HIV infections, new AIDS diagnoses, people living with HIV/AIDS, and AIDS deaths. When looking at CDC and U.S. Census data, blacks and Latinos account for a disproportionate share of new HIV infections, relative to their size in the U.S. population. As seen above, the rate of new HIV diagnoses per 100,000 for blacks is more than 8 times greater than that of whites (62 percent compared to 7.3 percent). The rate of new HIV diagnoses for Latinos and Native Hawaiian and Pacific Islanders, the next highest groups, is more than twice that of whites, at 20.4 percent and 19.3 percent respectively.
Read more information about HIV/AIDS in the U.S. in The HIV/AIDS Epidemic in The United States. More information about the data presented above can be found in JAMA online in HIV/AIDS: The State Of The Epidemic After 3 Decades.
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