Health disparities

Children of color more likely to die from flu, study finds

People who are Black, Hispanic or American Indian/Alaska Native are more likely than white people to be hospitalized with a case of the flu in the United States, according to a recent study from the Centers for Disease Control and Prevention and other institutions (Source: “The flu proves more deadly for children of color than for White youths, study says,” Washington Post, Oct. 11).

Young children in these groups, along with Asian and Pacific Islander children, are also more likely to die of flu than white children.

The study, published in the journal JAMA Network Open, took a close look at 113,352 flu hospitalizations between 2009 and 2019 from across the country. Researchers found clear disparities in those hospitalizations as well as among those who were ultimately admitted to the intensive care unit or who died.

Overall, Black people had the highest rates of hospitalization and ICU admission, followed by American Indians or Alaska Natives and Hispanic people, although the trends varied within age groups. Except in the youngest children, Asian and Pacific Islander people had hospitalization rates similar to or slightly lower than non-Hispanic white people. Across racial and ethnic groups, researchers found few differences in hospitalization, ICU admission and death from flu among adults 75 and older.


New report highlights health inequities by state

Earlier this month, the creators of the America’s Health Ranking report released the first edition of a companion document focused on health disparities in the U.S. (Source: “United Health’s inaugural ‘Disparities Report’ highlights health inequities,” MinnPost, Aug. 4).

The inaugural edition of the United Health Foundation’s “American’s Health Ranking Disparities Report” described the breadth, depth and persistence of health disparities in the U.S.

While previous reports have focused on the health of seniors, the health of women or on those who’ve served in the U.S. military, this year’s report focused on areas where one group has a disadvantage compared to another. The study’s results were broken down by all 50 states and the District of Columbia.


White Americans got disproportionate share of healthcare dollars in 2016, study finds

White Americans received 72% of all healthcare spending in 2016 despite making up 61% of the population, according to a new study that found major disparities in racial and ethnic health spending (Source: “Study: White Americans got disproportionate amount of healthcare dollars in 2016,” Fierce Healthcare, Aug. 17).

The study, published last week in the Journal of the American Medical Association and conducted by the Institute for Health Metrics and Evaluation at the University of Washington, found that African Americans make up 12% of the population and accounted for 11% of healthcare spending. However, the spending was skewed based on how African Americans were getting care. African Americans got 26% less outpatient care compared to whites but spent 12% more on emergency department care, the study found. This likely contributed to African Americans getting more expensive care when conditions worsened instead of getting more preventive outpatient care, experts said.

“Hispanic and Asian Americans received the least spending relative to their proportion of the population: Hispanic patients benefited from 11% of healthcare spending despite accounting for 18% of the population, while Asian, Native Hawaiian and Pacific Islander individuals received 3% of spending while making up 6% of the population,” according to a release on the study.


Increased access to care insufficient for closing racial health gap, new studies find

A series of studies in the Journal of the American Medical Association found that while access to care has improved in recent years, the racial health gap has remained (Source: “Racial Inequities Persist in Health Care Despite Expanded Insurance,” New York Times, Aug. 17).

The new issue of JAMA offers studies on disparities in the utilization of health care services and in overall health spending. Together, the findings paint a portrait of a nation still plagued by medical haves and have-nots whose ability to benefit from scientific advances varies by race and ethnicity, despite the fact that the ACA greatly expanded insurance.

The racial health gap did not significantly narrow from 1999 to 2018, despite decreases in uninsured rates due to the passage of the Affordable Care Act, according to one study whose author said it was tantamount to “a comprehensive national report card.”

Despite innovations like Medicare Advantage, which increased access to health care overall, Medicare beneficiaries who are minorities — defined as Black, Hispanic, Native American or Asian-Pacific Islander — still have less access than white or multiracial individuals to a physician who is a regular source of care.

Overall, Black women face a much higher risk of dying from pregnancy complications than white women, with maternal mortality rates of 41.7 per 100,000 live births for Black women, compared with 13.4 per 100,000 live births for white women.


Medicare eligibility drives down racial disparities, study finds

Access to Medicare may help address racial disparities in insurance coverage, access and self-reported outcomes, according to a new study (Source: “Medicare eligibility erases many healthcare disparities in US,” Healthcare Dive, July 26).

The research, published in JAMA Internal Medicine, tracked more than 2.4 million Americans and found that immediately after turning 65, and thus becoming eligible for Medicare, coverage for Black respondents increased from 86.3% to 95.8%. Among Hispanic respondents, coverage increased from 77.4% to 91.3%.

The JAMA study has validated the importance of Medicare in terms of leveling the playing field for Americans when it comes to healthcare access — a gap that has been exacerbated by the COVID-19 pandemic. Whereas there are significant gaps in access to healthcare and disparities among ethnic groups, reaching Medicare age wipes much of them out.

Disparities in insurance coverage were cut by 53% between Black people and white people, and 51% for Latino people versus white people. The proportion of Black and Latino people who self-reported their health as poor also dropped significantly after they became eligible for Medicare.


Organizations aim to connect patients, therapists of color

A number of new organizations aim to digitally connect patients with mental health providers who value and understand different cultures (Source: “It’s Hard to Search for a Therapist of Color. These Websites Want to Change That.,” New York Times, July 16).

In recent years there has been an expanding number of digital companies and nonprofits created to help people of color find a therapist they can trust — someone who is not only skilled in the best evidence-based treatments but also culturally competent. In other words, a provider who is aware of their own world views, knowledgeable about diversity and trained to connect with different types of clients.

The founders of these organizations say there has always been a need for such services, and even more so now that people are coping with the stressors of the pandemic and the racial reckoning that followed the killing of George Floyd by the Minneapolis police.

Studies have shown that mental health treatments can be more effective when a client feels that their therapist values culture.

It can be difficult for people of color to locate a therapist with a shared cultural background.  An American Psychological Association report found that only 5% of psychologists are Hispanic and 4% are Black — 86% are white. A similar disparity exists among the country’s social workers and psychiatrists.


Study finds link between neighborhood disadvantage and COVID-19 disparities

New research has found a strong link between COVID-19 and neighborhood disadvantage, a finding that supports earlier contentions of the connection between social factors and coronavirus disparities (Source: “How Neighborhood Disadvantage Drove COVID Health Disparities,” Patient Engagement HIT, July 21).

The study examined the connection between COVID-19 inequity and subway ridership in New York City. Neighborhoods that ranked higher on a COVID-19 inequity index — meaning that the neighborhood saw more factors that could put inhabitants at risk — also had higher subway ridership even after COVID-19 forced city-wide shutdowns.

Daniel Carrión, a researcher from Mount Sinai, said needing to ride the subway — or work an essential job — had a strong link to the unequal infection rates seen during the height of the coronavirus pandemic, largely because it limits the ability to socially distance.

“For us, subway utilization was a proxy measure for the capacity to socially distance,” Carrión, a postdoctoral researcher in the Department of Environmental Medicine and Public Health at the Icahn School of Medicine, told PatientEngagementHIT in an interview.

Although public health experts have made the link between the social determinants of health leading to actual infection, not just poor outcomes, Carrión and his colleagues put some data behind that. Social disadvantage was linked with higher subway utilization, and ultimately to higher infection rates and starker disparities.

“Folks like me were able to stay home for the majority of the pandemic and work from home. I didn't need to use public transit whereas others did. What we found was that areas that had higher COVID inequity indices were also riding the subways more after the stay-at-home orders compared to folks that were low in the COVID inequity index.”


Low number of Black dermatologists could hurt quality of care, providers warn

For people of color, basic dermatological conditions sometimes go undiagnosed or misdiagnosed by doctors unfamiliar with treating darker skin, healthcare professionals say (Source: “Skin color matters: In dermatology, patients' diversity calls more Black doctors,” Columbus Dispatch, July 29).

According to a June 2017 study published in the Dermatology Journal of the American Medical Association, 3% of dermatologists in the United States were Black. In 2020, 13.4% of the U.S. population was Black or African American, according to the U.S. Census.

A lack of diversity in any medical field can hurt the quality of care given. And a doctor from one ethnic or racial background might be able to offer information not necessarily taught in school.


Researchers remove race from childbirth calculator in effort to advance equity

After years of work by researchers, advocates and clinicians, a calculator that used race as a factor to determine the likelihood of having a successful vaginal birth after cesarean has been replaced by a newly validated version that is the same in almost every way — except for eliminating race and ethnicity as a risk factor (Source: “Changing the equation: Researchers remove race from a calculator for childbirth,” Stat News, June 3).

The previous tool takes into account a patient’s age, height, weight and history of vaginal and cesarean delivery. It also asks two yes-or-no questions: “African-American?” “Hispanic?” The answers can predict a drastically lower chance of success for patients of color. But now, that racialized calculator has been replaced by a newly validated version that does not include inputting race or ethnicity information.

The VBAC calculator is just one of several clinical algorithms that have recently been challenged over their use of race adjustment. Providers across specialties have questioned the inclusion of race and ethnicity — which are social, not biological factors — in their decision-making tools, pointing to the risk of perpetuating existing health inequities. But because obstetricians access the VBAC calculator online, it could prove much easier than with other corrected tools to get the updated calculator quickly into use across the country.

“I think it’s powerful that this is, in some ways, the first example of race correction being abandoned systematically in a tool in response to these equity concerns,” said Darshali Vyas, a resident at Massachusetts General Hospital.


ICYMI: HPIO brief explores connections between criminal justice and health

The Health Policy Institute of Ohio last week released a new brief titled, Connections between Criminal Justice and Health.

According to the brief, “The research evidence is clear that poor mental health and addiction are risk factors for criminal justice involvement and that incarceration is detrimental to health.”

The brief highlights the many factors that impact both criminal justice and health outcomes, finding that:

  • There is a two-way relationship between criminal justice and health. Mental health and addiction challenges can lead to arrest and incarceration, and incarceration contributes to poor behavioral and physical health for many Ohioans.
  • Racism and community conditions contribute to criminal justice involvement and poor health. Racist and discriminatory policies and practices and community conditions, such as poverty, housing instability and exposure to trauma, lead to increased criminal justice involvement and drive poor health outcomes.
  • Improvement is possible. There are evidence-informed policy solutions to combat the drivers of criminal justice involvement and poor health outcomes.

The brief includes 15 specific evidence-informed policy options focused on:

  • Supporting mental well-being and improving crisis response for people at higher risk of criminal justice involvement
  • Reducing the number of people incarcerated in Ohio
  • Improving health for people who are currently or formerly incarcerated
  • Improving community conditions for people who are at higher risk of criminal justice involvement