Ohio Health Policy News

New research finds Black adults are more likely to visit emergency departments when experiencing a mental health problem than white adults but face longer delays, and are less likely to be admitted to a hospital for treatment (Source: “Study: Black People Visit ER for Mental Health at Highest Rates,” U.S. News, March 1).

A new analysis released Wednesday by the Centers for Disease Control and Prevention’s National Center for Health Statistics shows that from 2018 to 2020, non-Hispanic Black adults visited the emergency department for any mental health-related concern at an annual average rate of 97 visits per 1,000 adults, nearly double the rate of the national average. By comparison, the rate of mental health-related emergency department visits among non-Hispanic white adults was 53.4 per 1,000 from 2018 to 2020, while Hispanic adults had the lowest rate at 36 visits per 1,000.

The analysis did not examine contributing factors for the racial disparities found, but previous research has indicated people of color are routinely underdiagnosed and undertreated for mental illness, which has in part led to rising rates of drug overdose death and suicide.

A new study suggests that lack of access to food and the stress caused by food insecurity were associated with an increased risk of cardiovascular disease (Source: “Food insecurity can affect heart disease, research says,” Dayton Daily News, Feb. 13).

A recent JAMA study found economic food insecurity was associated with risks of coronary heart disease and these associations persisted after further adjustment for diet quality and perceived stress. High frequency of unfavorable food stores was not associated with coronary heart disease, heart failure, or stroke, researchers said. Researchers pointed to economic food insecurity as a potential target for intervention to improve health outcomes.

Food insecurity disproportionately impacts Black, Hispanic and single-parent households. The U.S. Department of Agriculture found in 2018 that 11.1% of all U.S. households were food insecure — with 13.9% of all households with children also food insecure.

Less than a third of studies investigating social determinants of health interventions include race and ethnicity in their analyses, and even fewer stratify outcomes by race, a new study found (Source: “Few Studies Assess Social Determinants of Health Intervention by Race,” Patient Engagement HIT, Jan. 20).

According to the study from University of California San Diego Health researchers, the lack of data disaggregated by race stymies any efforts to understand how social determinants of health interventions can address racial health disparities.

“Over the last decade, achieving health equity has been heralded as a key priority for health care delivery organizations,” the researchers wrote in JAMA Network Open. “Achieving health equity requires addressing root causes of health inequities, including inequities in social and structural drivers (determinants) of health.”

Analysis included in HPIO’s policy brief, Health Impacts of Tobacco Use in Ohio, found that while overall smoking rates have declined over the past three decades, this has not been the case for people with low incomes. As a result, low-income communities experience a much greater impact of tobacco use than communities with higher incomes. In 1995, Ohioans with very low incomes (less than $15,000 a year) were 36% more likely than those with higher incomes ($50,000 or more a year) to smoke cigarettes. By 2020, this gap had increased to 107%, as illustrated in the graphic above.

Research by the federal Office of the National Coordinator for Health IT has found racial and ethnic disparities in patient access to, and usage of, electronic health records (Source: “Report confirms racial disparities in patient access to their health data,” Healthcare IT News, Jan. 5).

Published in the Journal of the American Medical Informatics Association, the ONC study found that in 2019 and 2020, "black and Hispanic individuals were significantly less likely to report being offered and subsequently accessing their portal."

Black and Hispanic people were not offered (5.2 percentage points less likely) and did not access patient portals (7.9 percentage points less likely) nearly as often as white people. 

But when offered access, disparities largely diminished. According to the study, "individuals offered a portal and encouraged to use it by their providers "were 21 percentage points more likely to access it."

"Taken together, our findings point to the important role of healthcare providers in increasing access to EHI by offering portals and encouraging their use," study coauthor Chelsea Richwine, an economist with ONC's Office of Technology, wrote.

New evidence suggests that the shrinking gap in U.S. COVID-19 racial death disparities is being driven by political division and increasing total deaths — mostly among white people — rather than by decreasing deaths among Black Americans (Source: “Study: US political divide may help explain shrinking racial COVID death gap,” Center for Infectious Disease Research and Policy, University of Minnesota, Nov. 1).

According to a new University of Wisconsin and UCLA study published in PLOS One, Black people still bear a larger COVID-19 death burden than white people, despite a relatively younger population, but suggest that a wider political chasm likely drove more deaths in the latter group as the pandemic evolved.

Researchers examined COVID-19 death disparities since the early months of the pandemic when Black Americans had far higher death rates than their white peers.

Black and Hispanic Americans are much more likely to work in jobs that must be done in person, leading to much higher exposure to the virus. "That didn't change as the racial differences in the mortality rate shifted," lead author Adeline Lo said. "Other factors — like geographical distribution, healthcare access, income equality — that contributed to the initial higher rate of Black deaths didn't go away either."

What did change was that levels of concern about COVID and adherence to protective public health measures (eg, lockdowns, closures, prohibitions on gathering) widened along political lines, with increasing deaths among white Americans. After initially issuing similar state mandates in the first few weeks of the pandemic, within one month, Republican-controlled states began lifting public health restrictions, lessening virus containment and leading white deaths to surpass those of Black people from April to October 2020.

People of color with a COVID-19 diagnosis were much less likely to receive Paxlovid and other treatments than white patients, according to new data from the Centers for Disease Control and Prevention (CDC) (Source: “CDC data: People of color much less likely to receive Paxlovid, other COVID treatments,” The Hill, Oct. 27).
 
The CDC findings are consistent across all age groups and underscore the persistent disparities surrounding access to COVID-19 treatments, especially the antiviral pill Paxlovid. Paxlovid is the most commonly prescribed medication and the preferred outpatient therapeutic for eligible patients, according to the CDC.
 
During a four-month period from April to July 2022, Paxlovid treatment was 36% lower among Black patients relative to white patients and 30% lower among Hispanic patients relative to non-Hispanic patients, according to the study.

A new study shows significant disparities in vision function among Black, Hispanic and poorer adolescents (Source: “Lack of Access Appears Tied to Disparities in Vision Health,” U.S. News, Sept. 16).

New research suggests a lack of access to vision care services has contributed to racial, ethnic and socioeconomic disparities in visual function among Black, Hispanic and poorer adolescents.

Findings of a new study published last month in JAMA Ophthalmology reveals approximately 16% of Black and 18% of Mexican American adolescents had worse than 20/40 vision in their better-seeing eye compared to 7% of white adolescents. After correcting for visual impairment, 3% of Black and 3% of Mexican American adolescents still had worse than 20/40 vision compared to 1% of white adolescents.

Study co-author Dr. Idsin Oke, a clinical scientist and pediatric ophthalmologist at Boston Children’s Hospital, said the findings highlight the importance of addressing barriers that could hinder access to vision care services for racial and ethnic minority youth.

A new report estimates that racial mental health disparities cost the United States around $278 billion between 2016 and 2020, putting a price tag on a health equity issue that’s long plagued the nation (Source: “Racial Mental Health Disparities Cost US $278B in 4 Years,” Patient Engagement, HIT, Sept. 14).

According to the report from Satcher Health Leadership Institute at Morehouse School of Medicine, between 2016 and 2020, the U.S. saw an excess of 117,000 premature deaths among indigenous and racial or ethnic minorities due to mental health needs, adding $278 billion in excess costs.

“Investing in mental healthcare saves lives and dollars — we have known this for decades, but until now did not fully understand the monumental impacts of neglecting to act,” Daniel E. Dawes, a professor and the executive director of the Satcher Health Leadership Institute, said in a statement.

As national and state organizations mark September as Suicide Prevention Awareness Month, data show that while suicide deaths among young Ohioans have risen overall in Ohio over the past two decades, the increase has been sharpest among Black Ohioans.

In 1999, the suicide rates for both white Ohioans and Black Ohioans ages 10 to 24 were the same: 6.8 per 100,000 people. By 2020 (the most recent year for which data is available), the rate for white Ohioans had risen to 11.2 (an increase of 64%) and the rate for Black Ohioans had risen to 12.8 (an increase of 88%).

More-recent national research indicates that the disparity in suicide rates may have increased during the COVID-19 pandemic.

Reducing suicide and eliminating disparities are priorities of the Ohio Department of Health’s 2020-2022 State Health Improvement Plan (SHIP). Public- and private-sector leaders can implement strategies identified in the SHIP and Ohio’s 2020-2022 Suicide Prevention Plan, including suicide fatality review boards, behavioral health integration with primary care and education on safe storage of lethal means (i.e., firearms and medications).

If you or someone you know is experiencing emotional distress or a suicidal crisis, please call the 988 Suicide and Crisis Lifeline; the Trans Lifeline at 877-565-8860 or the Trevor Project at 866-488-7386. If you don’t like talking on the phone, consider using the Crisis Text Line at www.crisistextline.org or text “4HOPE” to 741-741.