Racism and health

Federal study finds racial disparities in access to health data

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.


Pregnancy complications worse among Black women in Ohio, data shows

Urban centers are seeing the highest rates of pregnancy complications for Ohio women, followed by Appalachia, with Black women being impacted the most, a report from HPIO found (Source: “Severe pregnancy complications are affecting Black women in Ohio the most,” Ohio Capital Journal, Nov. 28).

The brief, Racial and Geographic Disparities in Maternal Morbidity and Mortality, points to systemic racism, a lack of health care access and poor community conditions as reasons for the disparities.

Not only are there disparities in general maternal health, but also in maternal morbidity: severe complications that happen during or after labor and delivery that can lead to other major health problems, including hysterectomy or the need for a blood transfusion, according to the brief.


Study finds U.S. political divides may explain reduced racial disparities in COVID deaths

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.


CDC data shows people of color less likely to receive Paxlovid, other COVID treatments

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.


Disparities in vision health linked to access challenges, study finds

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.


Graphic of the week

Dashboard_DisparitiesGraphic_StandAlone

 

HPIO’s 2021 Health Value Dashboard concluded that one reason Ohio ranks poorly (47th out of the 50 states and D.C.) is that many Ohioans experience poorer outcomes and live shorter lives because of policies, systems and beliefs that discriminate against and unfairly limit access to resources. According to the Dashboard, racism and other forms of discrimination drive troubling differences in outcomes across Ohio. This includes racist and discriminatory beliefs and interactions among Ohioans and structural racism and discrimination embedded within systems and across sectors, rooted in ageism, ableism, xenophobia, homophobia and other “isms” or “phobias.”  As the graphic above shows, Ohioans experiencing the worst health outcomes are also more likely to be exposed to risk factors for poor health. These include trauma and adversity, toxic stress, violence and stigma, and inequitable access to resources.

Earlier this week, HPIO hosted the first meeting of its Health Value Dashboard Advisory Group as it begins planning for the 2023 Dashboard. The new edition is expected to be released in March or April 2023.


Study finds race, ethnicity are seldom mentioned in pediatric clinical guidelines

Race and ethnicity were unexplored in most American pediatric clinical practice guidelines published in the last 5 years, according to the results of a systematic review (Source: “Race unexplored in most pediatric clinical care guidelines, review finds,” Helio, June 13).

According to the study, which was published in JAMA Pediatrics, 70% of the guidelines did not mention race or ethnicity at all. The researchers also found that when race or ethnicity was mentioned, 57% of the time it was used in a way that could exacerbate or have a negative impact on inequities and only 15.1% of clinical practice guidelines include language specifically intended to reduce disparities in medicine.

“I think that shows a missed opportunity for us as medical organizations to be proactive in talking about health care inequities and systemic racism in our field,” said Courtney A. Gilliam, MD, a member of the division of hospital medicine in the department of pediatrics at Seattle Children’s Hospital and a co-author of the review. “We have a long way to go in interrogating clinical practice guidelines.”


Faulty oxygen readings added to COVID-19 disparities, study finds

Covid-19 care, including distribution of lifesaving therapies, was significantly delayed for Black and Hispanic patients due to inaccurate oxygen readings from devices that can work poorly in darker-skinned individuals, according to a new study (Source: “Faulty oxygen readings delayed Covid treatments for darker-skinned patients, study finds,” Stat News, May 31).

Widely used pulse oximeters, which measure oxygen levels by assessing the color of the blood, have been under increasing scrutiny for racial bias because they can overestimate blood oxygen levels in darker-skinned individuals and make them appear healthier than they actually are. A 2020 study comparing oxygen levels measured by the devices with readings taken from “gold standard” arterial blood samples found pulse oximeters were three times less likely to detect low oxygen levels in Black patients than in white patients. Two months after that report, the Food and Drug Administration issued a safety communication alerting patients and clinicians that the devices could be erroneous in those with dark skin.

The new study, published in May in JAMA Internal Medicine, found that  the inaccuracies in oxygen measurement occurred at higher rates not only in Black patients, but also in Hispanic and Asian patients, compared to white patients. Those inaccuracies had real-world consequences. The study provided evidence that undetected low oxygen levels led to delays in Black, Hispanic and Asian patients receiving potentially lifesaving therapies such as the drugs remdesivir and dexamethasone, and in many cases, led to patients not receiving treatment at all.


Baby formula shortage puts spotlight on long-standing health disparities

As parents across the United States struggle to find formula to feed their children, the pain is particularly acute among Black and Hispanic women, who have historically faced obstacles to breastfeeding, including a lack of lactation support in the hospital, more pressure to formula feed and cultural roadblocks (Source: “Baby formula shortage highlights racial disparities,” Associated Press, May 27).

Low-income families buy the majority of formula in the U.S. and face a particular struggle: Experts fear small neighborhood grocery stores that serve these vulnerable populations are not replenishing as much as larger retail stores, leaving some of these families without the resources or means to access formula.

The Centers for Disease Control and Prevention estimates that 20% of Black women and 23% of Hispanic women exclusively breastfeed through six months, compared to 29% of white women. The overall rate stands at 26%. Hospitals that encourage breastfeeding and overall lactation support are less prevalent in Black neighborhoods, according to the CDC.

The racial disparities reach far back in America’s history. The demands of slave labor prevented mothers from nursing their children, and slave owners separated mothers from their own babies to have them serve as wet nurses, breastfeeding other women’s children. In the 1950s, racially targeted commercials falsely advertised formula as a superior source of nutrition for infants. And studies continue to show that the babies of Black mothers are more likely to be introduced to formula in the hospital than the babies of white mothers.


Study: Communities of color have much higher air pollution rates

A block-by-block analysis of air quality in the San Francisco Bay area found that communities of color are exposed to 55% more of a chemical that contributes to smog than mostly White communities (Source: “Block-by-block data shows pollution’s stark toll on people of color,” Washington Post, May 25).

The data released Tuesday by Aclima, a California-based tech company that measured the region’s air quality block-by-block for the first time. While the Environmental Protection Agency gauges an area’s air quality with fixed monitors, the new survey unearthed more granular data by sending low-emission vehicles equipped with sophisticated technology to traverse neighborhoods at least 20 times each.

These forays revealed that poor people of all ethnicities experience a 30% higher exposure to nitrogen dioxide compared to wealthier residents, and concentrations can vary up to 800% from one end of a block to the next.