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September 28, 2007
Health Disparities between Rich and Poor New Yorkers
From NYTimes.com:
The gap between the health of New Yorkers living in poverty and those with higher incomes has widened since the early 1990s, according to a survey released yesterday. It found that residents of poor neighborhoods in the city are experiencing alarming rates of diabetes and steady increases in other chronic illnesses like heart disease, while other residents have seen slower increases or even declines.
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Posted by: David Porter on September 28, 2007
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Category: Health Disparities
September 27, 2007
Disparities and Consumer-Directed Health Care
M. Gregg Bloche writing in Health Affairs: (subscription required)
First, I warn that adoption of the consumer-directed model as urged by its strongest advocates would probably widen socioeconomic disparities in care and redistribute wealth in "reverse Robin Hood" fashion, from the working poor and middle classes to the well-off. Moreover, racial and ethnic disparities in care would probably worsen. Second, I contend that these worrisome effects could be alleviated by adjustments to the consumer-directed paradigm. Possible fixes include more-progressive tax subsidies, tiering of cost-sharing schemes to promote high value care, and reducing deductibles and copayments for the less well-off. These fixes, though, are unlikely to gain traction. If consumer-directed plans achieve market dominance, disparities in care by class and race will probably grow.
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Posted by: David Porter on September 27, 2007
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Category: Health Disparities
September 26, 2007
Disparity in Bariatric Surgery
From the September 26, 2007 issue of JAMA (subscription may be required):
Bariatric surgery is the only health care intervention that facilitates significant and sustained weight loss. Surgery results in remission of diabetes in 80% to 90% of obese patients with diabetes, and reduces the risk of death associated with obesity by nearly 30%.
The demographic characteristics of patients who have bariatric surgery are not reflective of individuals with severe obesity in the United States. For example, nearly 84% of patients who undergo the surgery are women, more than 90% are white, and most have higher income levels.
The commentary goes on to say that blacks, Hispanics, and those with low incomes are more likely to be obese and that obesity in these groups "have even greater devastating social and clinical consequences."
The entire commentary is well worth the read.
Coming Up:
The next presentation in our Works in Progress series, held in collaboration with the Center for Health Equity, will be at Cleveland State on Friday, October 12 from 3-4 p.m.
Kenneth Sparks, PhD will present, 'The Effective Community: Education on Disease Risk in Hispanic Females.'
RSVP to Kendra Daniel at k.daniel@csuohio.edu or by phone 216-687-4704.
Send news items related to health disparities to ReduceDisparity(AT)case.edu
Posted by: David Porter on September 26, 2007
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Category: Health Disparities
September 25, 2007
Racism's Physical Toll
From latimes.com:
The reaction [to race-based discrimination] contributes to a chain of biological events known as the stress response, which can put people at higher risk of cardiovascular disease, diabetes and infectious disease, says Namdi Barnes, a researcher with the UCLA center. That protective response includes the release of cortisol, often called the stress hormone. It increases blood pressure and blood sugar levels and suppresses the immune system. Those are all good things when it comes to fleeing a wild beast or a suspicious sound in a dark parking lot. But for many African Americans, these responses may occur so frequently that they eventually result in a breakdown of the physiological system.
"This whole phenomenon of cumulative biologic stress is real," says Nicole Lurie, director of the Rand Center for Population Health and Health Disparities.
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Posted by: David Porter on September 25, 2007
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Category: Health Disparities
September 24, 2007
Definition of 'Emergency Care'?
NYTimes.com is reporting that the federal government will no longer consider chemotherapy 'emergency care.'
The federal government has told New York State health officials that chemotherapy, which had been covered for illegal immigrants under a government-financed program for emergency medical care, does not qualify for coverage. The decision sets the stage for a battle between the state and federal governments over how medical emergencies are defined.
At issue is the definition of 'emergency care.'
Some states have maintained that any time a patient is able to schedule an appointment — as opposed to showing up at an emergency room — the condition would not be considered an emergency. Others, including New York, have defined an emergency as any condition that could become an emergency or lead to death without treatment.
Under a limited provision of Medicaid, the national health program for the poor, the federal government permits emergency coverage for illegal immigrants and other noncitizens. But the Bush administration has been more closely scrutinizing and increasingly denying state claims for federal payment for some emergency services, Medicaid experts said.
Last year the Atlanta Business Chronicle wrote about how this issue is affecting Grady Memorial Hospital.
Grady and other hospitals fear they will end up footing the bill for illegal immigrants in the long run. They say immigrants denied care for chronic illness will only grow sicker, forcing them to return to the emergency room in a worsened condition.
"It's a tremendous burden that Grady must face," said state Sen. Don Thomas, R-Dalton. "They can't simply turn them away because they can't pay, whether they come into the emergency room or for chronic care."
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Posted by: David Porter on September 24, 2007
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Category: Health Care
September 21, 2007
Clinical and Translational Science Award
Center Director Ash Sehgal, MD on WCPN.
We want to encourage and facilitate a different kind of research where researchers and community members act as equal partners. They jointly decide how the data should be collected and they jointly interpret, disseminate and act on the findings of those data.
You can hear the audio at WCPN.org.
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Posted by: David Porter on September 21, 2007
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Category: About Us
September 20, 2007
$6 Million NIH Grant Awarded to Center for Reducing Health Disparities
The Center for Reducing Health Disparities Receives $6 million grant from the National Institutes of Health to study and address disparities related to hypertension and kidney disease in Cleveland.
A summary of the proposed work is below.
Cleveland is characterized by an extremely high poverty rate, substantial numbers of racial/ethnic minorities, and marked health disparities. We propose to engage Cleveland's health care providers, educational institutions, community organizations, and government agencies to understand and reduce health disparities. To take advantage of pre-existing community and institutional strengths, we will focus initially on 3 inter-related prototypical conditions: hypertension, kidney disease, and transplantation. These conditions affect many individuals and have some of the most striking health disparities observed in the United States.
The Research Core includes projects that involve (a) utilizing lay health advisors to help patients address the social contextual factors that act as barriers to hypertension management, (b) utilizing interpreters as advocates for Spanish speaking patients with hypertension or kidney disease, and (c) utilizing transplant recipients as navigators to improve access to kidney transplantation.
The Research Training/Education Core involves (a) recruiting students, particularly from minority backgrounds, into undergraduate, graduate, and postdoctoral programs related to health disparities, (b) providing diverse educational opportunities relevant to health disparities research, and (c) supporting postdoctoral students and junior faculty, particularly from underrepresented groups, to ensure successful entry into academic positions.
The Community Engagement/Outreach Core involves a community-based video intervention to enhance signing of organ donor cards. The Administrative Core will coordinate and foster interactions across projects/cores, provide shared resources and personnel, assist in other community efforts to address disparities, lead interactions with other NCMHD Research Centers of Excellence, disseminate findings, and develop future initiatives.
Each of the three research projects as well as the Community Engagement/Outreach Core focus on testing interventions to reduce health disparities. Moreover, the design of these interventions is informed by an understanding of the mechanisms that created health disparities in each of the areas studied.
Other strengths and innovative features of our application include selection of projects through a community-wide approach, a strong institutional commitment, and the experience and commitment of the study team. In addition, the proposed projects have been designed not only to address an important aspect of health disparities but also to set the stage for future larger scale efforts. The community and institutional infrastructure established as a result of conducting these projects will be used in future efforts that target a broader range of conditions.
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Posted by: David Porter on September 20, 2007
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Category: About Us
September 19, 2007
Inadequate Health Care for Native Americans
From indiancountry.com:
Sen. Byron Dorgan, D-N.D., and Sen. Jon Tester, D-Mont., addressed IHS officials at a field hearing Aug. 16 on the Crow Nation Reservation.
"I am out of patience with the inadequate health care for Native Americans; we don't have a lot of time," Dorgan said.
Tester, the freshman senator and a member of the Senate Committee on Indian Affairs, said that tribes signed treaties with the federal government and gave up land in exchange for services like health care.
And later in the article.
A top issue with health care is contract health - when funds run out mid-year, people have to wait for treatment until the next funding cycle unless they are threatened with loss of life or limb.
Contract health service funds are made available when a service unit is not equipped to handle a particular health issue. The patient is then referred out of the system and the contract funds will pay for the treatment. In most cases, this involves surgery and diagnostic tests.
The Crow Nation, according to Venne, was out of contract funds in the first part of June. Patients then must wait until November to receive special treatments. The wait for non-Indians to receive this type of care can be as much as three months, but for American Indians who use the IHS system, a 13-month wait is not unusual.
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Posted by: David Porter on September 19, 2007
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Category: Health Disparities
September 18, 2007
Disparity in state health care spending
NYTimes.com reporting on a new article in Health Affairs (subscription may be required.)
A new federal study shows huge variations in personal health spending among states, ranging from an average of nearly $6,700 a person in Massachusetts to less than $4,000 in Utah.
It is interesting that not all health care spending is the same.
The researchers noted differences among states with the highest health spending. Massachusetts, for example, has higher per capita spending on hospital care than any other state, while Maine spends more than other states on home and community-based care. Maine had the second highest level of spending on doctors’ services, after Alaska.
According to the author's data (Exhibit 1), Ohioans spent more per capita on health care than the national average in 1991, 1998, and 2004. Personal health care spending grew in Ohio 4.8% from 1991-1998 and 7.4% from 1998-2004.
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Posted by: David Porter on September 18, 2007
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Category: Health Disparities
September 17, 2007
Doctor-patient disconnect?
Tracy Wheeler writing in the Beacon Journal reports on how different ethnic populations expect to be treated by their doctor.
In focus groups, Asians said [they] want doctors and nurses to speak more slowly and clearly, and to ''explain things until I understand.'' Eastern Europeans saw a need for interpreters. Muslims said they felt rushed at doctors' appointments. African-Americans wanted more easy-to-understand medical information. Only Hispanics said that doctors routinely go out of their way to communicate with patients, despite language barriers.
However some worry about the effect of focusing on cultural expectations.
Findings like these "give me the heebie-jeebies," said Dr. Joseph Zarconi, Summa's vice president of medical education and research. While the quest to serve a diverse population is "very right-minded," the effort often leads to "misguided strategies."
Zarconi worries that such efforts can lead to stereotyping, or a belief that all members of a certain race or religion are the same. He said that could contribute to poor health care as much as cultural insensitivity.
It's not about race and ethnicity, he said. It's about a person's life experience.
Just because two patients happen to be 52-year-old black men doesn't mean they have similar lives. Just as two heart-attack patients aren't necessarily the same.
"It's up to us to ask, 'What's going on in your life?'" he said.
Coming Up:
The next presentation in our Works in Progress series, held in collaboration with the Center for Health Equity, will be at Cleveland State on Friday, October 12 from 3-4 p.m.
Kenneth Sparks, PhD will present, 'The Effective Community: Education on Disease Risk in Hispanic Females.'
RSVP to Kendra Daniel at k.daniel@csuohio.edu or by phone 216-687-4704.
Send news items related to health disparities to ReduceDisparity(AT)case.edu
Posted by: David Porter on September 17, 2007
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Category: Health Disparities
September 11, 2007
Disparity in nursing home care
From Reuters:
Elderly and ill blacks in the United States are more likely to live in poor-quality nursing homes, researchers said on Tuesday in a study that shows clear patterns of segregation persist.
The study can be found in the journal Health Affairs.
Send news items related to health disparities to ReduceDisparity(AT)case.edu
Posted by: David Porter on September 11, 2007
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Category: Health Disparities
September 10, 2007
Racial differences in kidney cancer care
From Reuters:
Dr. Sonja I. Berndt from the National Cancer Institute in Bethesda, Maryland and colleagues examined data for 964 black and 10,482 white Medicare beneficiaries with renal cell cancer.
Blacks were much more likely than whites to have other illnesses, in addition to kidney cancer, the authors found.
Blacks survived a median of 2.5 years, while whites survived a median of 3.2 years, the investigators report, but this difference was eliminated when they adjusted for other illnesses present in blacks and treatment type.
"Although the reasons for the disparity in treatment are not entirely clear and need to be examined in future studies," the authors conclude, "this study suggests black patients may benefit from efforts to improve the availability of health care and interventions to reduce comorbid illness."
The study can be found in the Journal of Clinical Oncology.
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Posted by: David Porter on September 10, 2007
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Category: Cancer; Disparities; Health Disparities; Kidney Cancer
September 06, 2007
Scheduling an appointment. Botox vs. Moles
From NYTimes.com:
Patients seeking an appointment with a dermatologist to ask about a potentially cancerous mole have to wait substantially longer than those seeking Botox for wrinkles, a study published online yesterday by The Journal of the American Academy of Dermatology said.
Researchers reported that dermatologists in 12 cities offered a typical wait of eight days for a cosmetic patient wanting Botox to smooth wrinkles, compared with a typical wait of 26 days for a patient requesting evaluation of a changing mole, a possible indicator of skin cancer.
Original research available at the Journal of the American Academy of Dermatology.
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Posted by: David Porter on September 06, 2007
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Category: Health Care