Health disparities

Study: Americans with lower incomes more likely to have respiratory illnesses

Despite improvements in air quality and other advances, Americans with low incomes more often have asthma, lung disease and related illnesses, a new study has found (Source: “Poor Americans More Likely to Have Respiratory Problems, Study Finds,” New York Times, May 28).

In recent decades, air quality has improved in the United States, smoking rates have plummeted and government safety regulations have reduced exposure to workplace pollutants. But rich and poor Americans have not benefited equally, scientists reported in a paper on Friday.

While wealthier Americans have quit smoking in droves, tobacco use remains frequent among the poor. Asthma has become more prevalent among all children, but it has increased more drastically in low-income communities. And Americans with lower incomes continue to have more chronic lung disease than the wealthy.

The analysis, which was published in JAMA Internal Medicine, included data from national health surveys conducted by the Centers for Disease Control and Prevention periodically from 1959 to 2018. The study did not examine disparities in respiratory health by race or ethnicity, though it assessed both income-based and education-based differences in lung health.

Before the 1980s, smoking rates did not vary much by income, and they only slightly varied by education level: 62% of the wealthiest adults and 56% of the poorest were either current or former smokers. But that has changed drastically. By the survey period 2017-18, current and former smoking rates among the wealthiest dropped by nearly half to 34% — while rates among the poorest inched up to 57.9%.


New tool tracks health disparities in U.S.

A coalition of researchers and advocates launched a tool this week they hope will fill some of the gaps in data on racial disparities in the U.S. health system (Source: “A new tool tracks health disparities in the U.S. — and highlights major data gaps,” Stat News, May 26).

The Health Equity Tracker is a portal that collects, analyzes and makes visible data on some of the inequities entrenched in U.S. medicine.

“For far too long it’s been ‘no data, no problem,’” said Nelson Dunlap, chief of staff at the Satcher Health Leadership Institute at Morehouse School of Medicine, which developed the tool with funding and resources from Google.org, Gilead Sciences, Annie E. Casey Foundation and CDC Foundation.

By making data accessible that highlights racial health disparities, the tracker aims to empower local advocates to drive change in their communities — and inspire action to fill in holes in data that are themselves reinforced by structural racism. In the tracker’s display, 38% of federally-collected COVID-19 cases report unknown race and ethnicity.


CDC director declares racism ‘a serious public health threat’

In a statement released earlier this month, the director of the Centers for Disease Control and Prevention declared racism a “serious public health threat” (Source: “CDC Director Declares Racism A 'Serious Public Health Threat',” National Public Radio, April 8).

In the statement, Dr. Rochelle Walensky said that, “Racism is a serious public health threat that directly affects the well-being of millions of Americans. As a result, it affects the health of our entire nation. Racism is not just the discrimination against one group based on the color of their skin or their race or ethnicity, but the structural barriers that impact racial and ethnic groups differently to influence where a person lives, where they work, where their children play, and where they worship and gather in community. These social determinants of health have life-long negative effects on the mental and physical health of individuals in communities of color."

The CDC also launched a new web portal, Racism and Health, that's designed to be a hub for public and scientific information and discourse on the subject.


Study finds widespread racial disparities in air quality

A new national study has found racial and ethnic disparities in the quality of air that Americans breathe (Source: “People of Color Breathe More Hazardous Air. The Sources Are Everywhere.,” New York Times, April 28).

According to the study, Black Americans are exposed to more pollution from every type of source, including industry, agriculture, all manner of vehicles, construction, residential sources and even emissions from restaurants. People of color more broadly, including Black and Hispanic people and Asian Americans, are exposed to more pollution from nearly every source.

The findings, which were published Wednesday in the journal Science Advances, came as a surprise to the study’s researchers, who had not anticipated that the inequalities spanned so many types of pollution.

The study builds on a wealth of research that has shown that people of color in America live with more pollution than their white neighbors. Fine particulate matter air pollution, known as PM 2.5, is harmful to human health and is responsible for 85,000 to 200,000 excess deaths a year in the United States.


Maternal morbidity higher in majority-Black neighborhoods, study finds

People who live in majority-Black neighborhoods have a higher likelihood for maternal health complications, according to a study released earlier this month (Source: “Majority-Black Neighborhoods See Maternal Health Disparities,” Patient Engagement HIT, April 13, 2021).

The new data from Penn Medicine, published in Obstetrics and Gynecology, found a 2.4% increase in maternal morbidity for every 10% increase in Black residents within a given neighborhood.

Previous data has shown that maternal morbidity, or any unexpected labor outcome with major long- or short-term consequences, have a disproportionate impact on Black women compared to white women. This health disparity exists even after controlling for factors such as education level and income, prompting many health equity experts to consider the role that structural racism and implicit bias can play in health outcomes.

“This study gives us a blueprint for addressing racial disparities in health care at the neighborhood and population-level,” said co-author Lisa Levine, MD, an assistant professor of Obstetrics and Gynecology at Penn. “Investing in neighborhoods that have been historically segregated, lacked access to government services, and subjected to racism will help to improve not only severe maternal morbidity, but also a host of other health outcomes for patients.”


Medical school enrollment among Black men, Native Americans declines

A comprehensive new analysis of 40 years of medical school admissions data found the number of Black men and Native American and Alaskan Native men and women has declined (Source: “After 40 years, medical schools are admitting fewer Black male or Native American students,” Stat News, April 28).

The two are the two most underrepresented in U.S. medical schools, and their numbers are getting worse, according to a study that was published this week in the New England Journal of Medicine. While Black male medical students accounted for 3.1% of the national medical student body in 1978, in 2019 they accounted for just 2.9%. Without the contribution of historically Black medical schools, just 2.4% would be Black men. The number of Native American students, both male and female, also declined, accounting for just a fraction of 1% of the nation’s roughly 22,000 medical students in 2019.

“It is absolutely dismal and appalling and quite frankly unacceptable,” said Demicha Rankin, an anesthesiologist who serves as associate dean of admissions for The Ohio State University Wexler Medical Center, where 25% of students come from underrepresented minority groups.


Ohio ranks near bottom in latest HPIO Health Value Dashboard

Ohio ranks 47 in the nation in health value compared to other states and D.C. according to the latest edition of the Health Value Dashboard, which was released earlier this week by the Health Policy Institute of Ohio.

“Ohioans live less healthy lives and spend more on health care than people in most other states,” according to the Dashboard.

Ohio has consistently ranked near the bottom on health value in each of the four editions of the Dashboard. Ohio’s overall health value ranking was 47 in 2014, 46 in 2017 and 46 in 2019. 

The Dashboard found that Ohio’s healthcare spending is mostly on costly downstream care to treat health problems. This is largely because of a lack of attention and effective action in the following areas:

  • Children. Childhood adversity and trauma have long-term consequences
  • Equity. Ohioans with the worst outcomes face systemic disadvantages
  • Prevention. Sparse public health workforce leads to missed opportunities for prevention

The Dashboard is a tool to track Ohio’s progress toward health value — a composite measure of Ohio’s performance on population health and healthcare spending. In ranked profiles, the Dashboard examines Ohio’s rank and trend performance relative to other states across seven domains. In addition, through a series of equity profiles, the Dashboard highlights gaps in outcomes between groups for some of Ohio’s most systematically disadvantaged populations.

The Dashboard includes examples of nine evidence-informed policies that could be adopted by Ohio policymakers and private-sector partners to make Ohio a leader in health value.


COVID vaccination rates lag for Black Ohioans

Of the more than 1.8 million Ohioans who have received at least one COVID-19 vaccination dose, only 5.6% went to Black Ohioans, who comprise about 13% of Ohio’s population (Source: “Black Ohioans are 13% of state population, but 5.6% of the vaccine recipients,” Ohio Capital Journal, March 5).

Part of the explanation for the gap: Black people comprise 14.3% of the general population in the U.S., according to 2019 census estimates. However, because of lower life expectancy, they comprise just 9.7% of the 65-and-up population, which most states have prioritized for the vaccines.

“It is likely a conglomeration of a number of different factors,” said Reem Aly, a vice president at the Health Policy Institute of Ohio. “It is going to be inequities we see in access to care, historically, we know that there is racism within the health care system and there is an understandable mistrust in Black communities of health care providers. That is certainly contributing to the issue.”


U.S. Senate bill would support campaigns to address COVID-19 disparities

As public health officials across the country struggle to get vaccination shots to the people hardest hit by the coronavirus pandemic, a Senate bill aims to address health inequities among communities disproportionately affected by the virus (Source: “Senate bill aims to reduce health disparities related to Covid-19,” NBC News, Feb. 25).

The COVID-19 Health Disparities Action Act, introduced Thursday by Sens. Bob Menendez, D-N.J., and Ben Cardin, D-Md., would support targeted and "culturally competent" public awareness campaigns about vaccines and preventive measures in underserved communities, such as wearing masks and maintaining social distance.

The bill would direct the Department of Health and Human Services, acting through the Centers for Disease Control and Prevention, to develop public awareness campaigns to address disparities in testing, hospitalizations and deaths among racial and ethnic minority groups. It would also instruct the health department to create grant programs for community-based public awareness campaigns about vaccinations, testing and preventative measures.


Report outlines state efforts to address racial disparities in maternal mortality

A new resource details efforts in states across the country to address racial disparities in maternal mortality (Source: “State Maternal Mortality Review Committee Membership and Recommendations,” National Academy for State Health Policy, Feb. 18).

The United States faces a growing maternal mortality crisis with a maternal death rate that is higher than other developed countries. Additionally, Black women are two-to-three times more likely to die from pregnancy-related causes than non-Hispanic white women.

To better understand the root causes of these deaths and develop recommendations to improve health outcomes, many states have formed maternal mortality review committees (MMRCs). The report includes charts and maps that describe each state’s MMRC membership and recommendations.