Suchergebnisse

Persistent racial and ethnic health disparities exist in the USA, despite decades of research and public health initiatives. Several factors contribute to health disparities, including (but not limited to) implicit provider bias, access to health care, social determinants, and biological factors. Disparities in health by race/ethnicity are unacceptable and correctable. The Patient Protection and Affordable Care Act is a comprehensive legislation that is focused on improving health care access, quality, and cost control. This health care reform includes specific provisions which focus on preventive care, the standardized collection of data on race, ethnicity, primary language and disability status, and health information technology. Although some provisions of the Patient Protection and Affordable Care Act have not been implemented, such as funding for the U.S. Public Health Sciences track, which would have addressed the shortage of medical professionals in the USA who are trained to use patient-centered, interdisciplinary, and care coordination approaches, this legislation is still poised to make great strides toward eliminating health disparities. The purpose of this manuscript is to highlight the unprecedented opportunities that exist for the Patient Protection and Affordable Care Act to reduce racial and ethnic disparities in health in the USA.

Introduction: Housing stability is an impor­tant determinant of health, but no studies to our knowledge have examined the spill-over effects of neighborhood eviction rates on individual risk of preterm birth (PTB) among African American women.Objective: We assessed whether living in a neighborhood with high eviction rates was associated with risk of PTB among African American women, and whether marital/co­habiting status modified the association.Methods: We spatially linked interview, medical record, and current address data from the Life-course Influences on Fetal Environments Study (2009-2011, N=1386) of postpartum African American women from Metropolitan Detroit, Michigan, to publicly available data on block-group level rates of eviction filings and judgements. PTB was defined as birth before 37 completed weeks of gestation and occurred in 16.3% of the sample (n=226). Eviction rate vari­ables were rescaled by their interquartile ranges (75th vs 25th percentiles). Women self-reported whether they were married to, or cohabiting with, the father of their baby during the in-person interview. We used Modified Poisson regression with robust er­ror variance to estimate relative risks of PTB associated with each eviction variable sepa­rately and included an interaction term with marital/cohabiting status (P<.10 considered significant) in adjusted models.Results: In the overall sample, neighbor­hood eviction filings and judgements did not predict PTB, but the associations were modified by marital/cohabiting status (P for interaction = .02, and .06, respectively). Among women who were married/cohabit­ing, those who lived in neighborhoods with high eviction filings (adjusted relative risk: 1.25, 95% CI: 1.06, 1.47) and eviction judgements (adjusted relative risk: 1.18, 95% CI: 1.05, 1.33) had higher risk of PTB than women who did not. Little evidence of an association was observed for women who were not married/cohabiting.Conclusions: Future studies should examine the mechanisms of the reported associations to identify novel intervention targets (eg, addressing landlord discrimina­tion) and policy solutions (eg, ensuring a living wage and providing affordable hous­ing assistance to everyone who qualifies) to reduce the burden of PTB among African Americans. Ethn Dis. 2021;31(2):197-204; doi:10.18865/ed.31.2.197