Background: Potentially preventable complications are monitored as part of the Maryland Hospital Acquired Conditions Program and are used to adjust hospital reimbursement. Few studies have evaluated racial-ethnic disparities in potentially preventable complications. Our study objective was to explore whether racial-ethnic disparities in potentially preventable complications after Cesarean delivery exist in Maryland. Methods: We performed a retrospective observational cohort study using data from the Maryland Health Services Cost Review Commission database. All patients having Cesarean delivery, who had race-ethnicity data between fiscal years 2016 and 2020 were included. Multivariable logistic regression modeling was performed to estimate risk-adjusted odds of having a potentially preventable complication in patients of different race-ethnicity. Results: There were 101,608 patients who had Cesarean delivery in 33 hospitals during the study period and met study inclusion criteria. Among them, 1,772 patients (1.7%), experienced at least one potentially preventable complication. Patients who had a potentially preventable complication were older, had higher admission severity of illness, and had more government insurance. They also had more chronic hypertension and pre-eclampsia (both P<0.001). Median length of hospital stay was longer in patients who had a potentially preventable complications (4 days vs. 3 days, P<0.001) and median hospital charges were approximately $4,600 dollars higher, (P<0.001). The odds of having a potential preventable complication differed significantly by race-ethnicity group (P=0.05). Hispanic patients and Non-Hispanic Black patients had higher risk-adjusted odds of having a potentially preventable complication compared to Non-Hispanic White patients, OR=1.26 (95% CI=1.05 to 1.52) and OR=1.17 (95% CI=1.03 to 1.33) respectively. Conclusions: In Maryland a small percentage of patients undergoing Cesarean delivery experienced a potentially preventable complication with Hispanic and ...
BACKGROUND: Obesity prevention has become a major focus of public health efforts in the United States. The Federal Government set forth national nutrition and physical activity recommendations to prevent obesity and promote well-being among children. A succinct message developed through a program in Maine "Let's Go! 5-2-1-0" summarizes these obesity prevention behaviors including ≥5 fruit and vegetables, ≤2 hours of screen time, ≥1 hour of physical activity, and 0 sugar sweetened beverages daily. The study evaluates racial/ethnic disparities among adolescents meeting the 5-2-1-0 targets in a nationally representative sample. METHODS: The 2011-2012 NHANES dataset was used to conduct a cross sectional analysis of Hispanic (n=287), non-Hispanic Black (n=321), Asian (n=145) and non-Hispanic White (n=234) adolescents 12-19 years old. The 5-2-1-0 targets were evaluated using dietary recalls, Global Physical Activity Questionnaire, and questions about sedentary activities. Differences in the proportion of racial/ethnic groups meeting the 5-2-1-0 targets were compared using chi-square tests. Logistic models accounting for the complex sampling design were used to evaluate racial/ethnic disparities in meeting the 5-2-1-0 targets. RESULTS: There were no adolescents that met all four 5-2-1-0 targets. Meeting individual targets and meeting none of the targets differed by racial/ethnic group. The study found 28% of White, 39% of Hispanic, 44% of Black and 35% of Asian adolescents met zero 5-2-1-0 targets. Adolescents from different racial/ethnic groups had increased odds of meeting no 5-2-1-0 targets compared to their White peers (adjusted odds ratio [95% Confidence Interval] – Hispanic: 1.76 [1.04-2.98], Black: 1.82[1.04-3.17], Asian: 1.48[1.08-2.04]). CONCLUSION: Understanding the uptake of national nutrition and physical activity recommendations is necessary to reduce future obesity and health consequences in adulthood. Despite national initiatives, adolescents in the United States are far from meeting the 5-2-1-0 targets and there are racial/ethnic disparities in meeting the recommendations.
Abstract Introduction Breast cancer is the most commonly diagnosed cancer and the 2nd leading cause of cancer-related deaths among women in the U.S. Although routine screening via mammogram has been shown to increase survival through early detection and treatment of breast cancer, only 3 out of 5 women age ?40 are compliant with annual mammogram within the U.S. and the state of Florida. A breadth of literature exists on racial/ethnic disparities in compliance with mammogram; however, few such studies include data on individual Black subgroups, such as Haitians. This study assessed the association between race/ethnicity and annual mammogram compliance among randomly selected households residing in the largely Haitian community of Little Haiti, Miami-Dade County (MDC), Florida. Methods This study used cross-sectional, health data from a random-sample, population-based survey conducted within households residing in Little Haiti between November 2011 and December 2012 (n = 951). Mammogram compliance was defined as completion of mammogram by all female household members within the 12 months prior to the survey. The association between mammogram compliance and race/ethnicity was assessed using binary logistic regression models. Potential confounders were identified as factors that were conservatively associated with both compliance and race/ethnicity (P???0.20). Analyses were restricted to households containing at least 1 female member age ?40 (n = 697). Results Overall compliance with annual mammogram was 62%. Race/ethnicity was significantly associated with mammogram compliance (P = 0.030). Compliance was highest among non-Hispanic Black (NHB) households (75%), followed by Hispanic (62%), Haitian (59%), and non-Hispanic White (NHW) households (51%). After controlling for educational level, marital status, employment status, the presence of young children within the household, health insurance status, and regular doctor visits, a borderline significant disparity in mammogram compliance was observed between Haitian and NHB households (adjusted odds ratio = 1.63, P = 0.11). No other racial/ethnic disparities were observed. Discussion Compliance with annual mammogram was low among the surveyed households in Little Haiti. Haitian households underutilized screening by means of annual mammogram compared with NHB households, although this disparity was not significant. Compliance rates could be enhanced by conducting individualized, mammogram screening-based studies to identify the reasons behind low rate of compliance among households in this underserved, minority population.
New York State (NYS) passed legislation authorizing pharmacists to administer immunizations in 2008. Racial/socioeconomic disparities persist in vaccination rates and vaccine-preventable diseases such as influenza. Many NYS pharmacies participate in the Expanded Syringe Access Program (ESAP), which allows provision of non-prescription syringes to help prevent transmission of HIV, and are uniquely positioned to offer vaccination services to low-income communities. To understand individual and neighborhood characteristics of pharmacy staff support for in-pharmacy vaccination, we combined census tract data with baseline pharmacy data from the Pharmacies as Resources Making Links to Community Services (PHARM-Link) study among ESAP-registered pharmacies. The sample consists of 437 pharmacists, non-pharmacist owners, and technicians enrolled from 103 eligible New York City pharmacies. Using multilevel analysis, pharmacy staff who expressed support of in-pharmacy vaccination services were 69% more likely to support in-pharmacy HIV testing services (OR, 1.69; 95% CI 1.39–2.04). While pharmacy staff who worked in neighborhoods with a high percent of minority residents were less likely to express support of in-pharmacy vaccination, those in neighborhoods with a high percent of foreign-born residents were marginally more likely to express support of in-pharmacy vaccination. While educational campaigns around the importance of vaccination access may be needed among some pharmacy staff and minority community residents, we have provided evidence supporting scale-up of vaccination efforts in pharmacies located in foreign-born/immigrant communities which has potential to reduce disparities in vaccination rates and preventable influenza-related mortality.
PURPOSE OF REVIEW: This review highlights the available data describing racial and ethnic health disparities among patients with rheumatoid arthritis (RA) in the United States from an epidemiological, disease activity and wider socioeconomic standpoint. RECENT FINDINGS: Despite centralized government initiatives to include more under-representative minority populations into research, many of the studies that examined RA still fail to include sizeable cohorts of races or ethnic groups other than Caucasian. Evidence is slowly mounting that individual, provider and system level barriers exist and contribute to unequal care that leads to poorer outcomes amongst patients with RA. As RA is a progressive disease, early treatment is crucial to delay functional decline – a narrow window for many minority patients who are disproportionality affected by disability. SUMMARY: In order to combat the inequality that exists amongst RA patients we must focus on why discrepancies exist on every level, system, physician, patient, and illness. Further research is needed to tease the complex interplay between race, SES, medical access and outcomes to explain the disparities found in RA.
People of color are overrepresented in our criminal justice system. One in three African American men born today will be incarcerated in his lifetime. In some cities, African Americans are ten times more likely to be arrested when stopped by police. With the national debate national focused on race, crime, and punishment, criminal justice experts are examining how to reduce racial disparities in our prisons and jails, which often serve as initial entry points for those who become entangled in the criminal justice system.This report, which relies on input from 25 criminal justice leaders, pinpoints the drivers of racial disparities in our jails, lays out common sense reforms to reduce this disparity, including increasing public defense representation for misdemeanor offenses, encouraging prosecutors to prioritize serious and violent offenses, limiting the use of pretrial detention, and requiring training to reduce racial bias for all those involved in running our justice system.
Anti-immigrant rhetoric and political actions gained prominence and public support before, during, and after the 2016 presidential election. This anti-immigrant political environment threatens to increase health disparities among undocumented persons, immigrant groups, and people of color. I discuss the mechanisms by which anti-immigrant stigma exacerbates racial/ethnic health disparities through increasing multilevel discrimination and stress, deportation and detention, and policies that limit health resources. I argue that the anti-immigrant sociopolitical context is a social determinant of health that affects mostly communities of color, both immigrants and nonimmigrants. Public health has a moral obligation to consider how immigration policy is health policy and to be prepared to respond to worsening health disparities as a result of anti-immigrant racism.
Anti-immigrant rhetoric and political actions gained prominence and public support before, during, and after the 2016 presidential election. This anti-immigrant political environment threatens to increase health disparities among undocumented persons, immigrant groups, and people of color. I discuss the mechanisms by which anti-immigrant stigma exacerbates racial/ethnic health disparities through increasing multilevel discrimination and stress, deportation and detention, and policies that limit health resources. I argue that the anti-immigrant sociopolitical context is a social determinant of health that affects mostly communities of color, both immigrants and nonimmigrants. Public health has a moral obligation to consider how immigration policy is health policy and to be prepared to respond to worsening health disparities as a result of anti-immigrant racism.
Health disparities research often focuses on the social patterning of health outcomes. Increasingly, there has been an emphasis on understanding the mechanisms perpetuating disparities, even after issues of patient access to health services are addressed. The following study utilizes a novel dataset of electronic medical records (EMR), radiology records, and U.S. Census data to investigate the racial/ethnic patterning of provider-patient communication among patients diagnosed with incidental medical findings requiring follow-up. My results indicate that racial/ethnic disparities in follow-up adherence stem from initial disparities in provider-patient communication. These communication disparities persist even after accounting for multiple socioeconomic, health, and provider characteristics, indicating a bias in medicine, whereby providers are less likely to communicate information about incidental medical findings to patients of color relative to White patients. This paper has important clinical implications, as it sheds new light on why we might see low adherence to medical advice among patients of color. Findings also have social, political, and policy relevance, as they suggest an important mechanism through which health inequalities persist. To finally eliminate racial/ethnic health inequalities in the United States, racial bias and discrimination within medical and public health infrastructures must be eliminated.
In 2006, the Brazilian Health Council approved a National Health Policy for the Black Population. The Policy is striking because it promotes the image of a biologically and culturally discrete black population in a nation where racial classification has historically been relatively fluid and ambiguous. It transforms established patterns of racialization by collapsing "brown" (pardo) and "black" (preto) Brazilian Census categories into a single "black population" (população negra) to be considered a special- needs group by the public health apparatus. This construction resembles the United States' dominant mode of racialization based on hypodescent and represents a significant departure from hegemonic portrayals of Brazil as a racially mixed nation. Furthermore, the Policy challenges national ideologies of racial and cultural unity by affirming the existence of an essential black body with specific health concerns, as well as an essential Afro-Brazilian culture that materializes in recommendations for culturally competent health care. As such, the Policy constitutes an important site for new negotiations of racial and cultural identity in Brazil. In this dissertation, I explore the political and social implications of treating racial and ethnic groups differently within Brazilian health care. I examine how the re-definition and medicalization of racial and cultural identities unfolds in public clinics, temples of Afro-Brazilian religion, and social movements based in São Luís and São Paulo, Brazil. Through an analysis of ethnographic data that I collected over twenty-four months, I assess the impact of recent developments in race- conscious health policy on Brazilians' lived experiences of race, ethnicity, and health disparities. I argue that the new Policy, and its associated health programs, signals the emergence of a new biopolitical paradigm in which the Brazilian state formalizes citizens' racial and ethnic differences in order to address inequalities among them. I also show that many aspects of these programs, which incorporate global discourses and concepts related to health equity, fail to resonate with Brazilian citizens' notions about race and health. Consequently, patients and healthcare providers often resist the new measures. The result is a disjuncture between policy and practice that ultimately hinders Brazil's efforts to reduce health inequalities among its citizens
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.
To reduce racial and ethnic disparities in health care, managers, policy makers, and researchers need valid and reliable data on the race and ethnicity of individuals and populations. The federal government is one of the most important sources of such data. In this paper we review the strengths and weaknesses of federal data that pertain to racial and ethnic disparities in health care. We describe recent developments that are likely to influence how these data can be used in the future and discuss how local programs could make use of these data.
Point (Overview): Interpersonal and institutional racial biases are the principal reasons for racial disparities in accessing health care and disparities in African Americans' health status, which can only be addressed by acknowledging and putting an end to interpersonal and institutional racial bias in the health care system that adversely affects the health status African-Americans. Counterpoint (Overview): The irrational structure of health care, which is based on ability to pay, rather than need is the main cause of racial disparities in health, which will not be equalized until the structure of the health care system is fixed or when African Americans' economic inequalities are addressed. Defining the Problem: The U.S. Department of Health and Human Services ("HHS") defines health disparities as differences in health between groups of people who have systematically experienced greater obstacles to health based on their racial group; socioeconomic status; or other characteristics historically linked to discrimination or exclusion. Decades of government reports and research studies have shown that racial disparities in accessing quality health care and health status continue to exist, particularly between African-Americans and Caucasians. The largest disparity in health status was and remains to be between African-Americans and Caucasians. In 1985, the Secretary of HHS issued a landmark report, the Heckler Report, which exposed the existence of racial disparities in the U.S. health care system (Office of the Director, 1985). In 2003, the groundbreaking Institute of Medicine Study ("IOM study") Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare acknowledged the continuation of racial disparities in health status and accessing health care and provided suggestions for the elimination of these disparities (IOM, 2003). Finally, in 2007 the National Healthcare Disparities Report ("NHDR") noted that racial disparities in health status and accessing quality health care were not getting smaller; instead the gaps had not only persisted, but also gotten worse (HHS 2008). In addition to these reports, empirical research studies have shown that racial disparities in health care have worsened. In 1985, 60,000 excess deaths occurred each year in minority populations. By 2005, an estimated 83,570 African-Americans died each year that would not die if African-American death rates were equivalent to Caucasian rates (Satcher, 2005). In fact, research studies have shown that in 1950 before the end of legalized racial segregation, the life expectancy rates of 65 year old African-Americans and Whites was the same. Since 1950, African-Americans' life expectancy has continued to decline even after the advent of Title VI of the Civil Rights Act of 1964 ("Title VI"), which granted them "equal" access to health care services. In response to this data, the government has issued several initiatives to put an end to racial disparities in access to health care and health status. In 1990, HHS issued the first national health initiative, which provides science-based ten-year national objectives for improving the health of all Americans. In the first national health initiative, called Healthy People 2000, one of the main objectives was to reduce health disparities among all Americans. In 1998, President Bill Clinton announced the Initiative to Eliminate Racial and Ethnic Disparities in Health Care that was supposed to eliminate racial and ethnic health disparities in six key areas of health status, including infant mortality, by the year 2010. In 2000, the Healthy People 2010 initiative was issued with an objective of eliminating racial disparities in health care. In 2010, the Healthy People 2020 initiative expanded the goal of eliminating racial disparities in health care to include achieving health equity and improving the health of all groups. In spite of all the research, government reports and initiatives, health care disparities persist and in some cases have worsened. A recent report estimated that 30.6%, or $230 billion, of direct medical expenditures between 2003 and 2006 were excess costs due to racial disparities in health status and access to health (LaViest, 2009). Scholars and researchers have asserted a panoply of causes for the continuation of racial disparities in access to quality health care and health care status, including, cultural differences, insurance status, socioeconomic status, and education levels. Yet, innumerable research studies show that even when all these factors are controlled racial disparities in health care persist, leaving race as the only plausible explanation for the continuation of disparities. But what does race have to do with it? Some argue that race means that there are biological differences that explain these disparities in health outcomes; however, biologically race differences accounts for at most .03% of genetic variation (Mak, 2006). Thus, if race plays a role in racial disparities, genetic research suggests that it is due to the social construction of race not biological differences. As Professors David Williams and Pamela Jackson noted, "race is a marker for differential exposure to multiple disease-producing social factors. Thus, racial [disparities] in health should be understood not only in terms of individual characteristics but also in light of patterned racial inequalities in exposure to societal risks and resources." (Williams and Jackson, 2005). Unfortunately, the significance of societal risks, such as racial bias in causing racial disparities in health care is often ignored. However, some credible and robust research studies have suggested that racial bias is the chief factor in the continuation of racial disparities in health care. There are three levels of racial bias: interpersonal, institutional, and structural. Interpersonal bias is the conscious (explicit) and/or unconscious (implicit) use of prejudice in interactions between individuals. Interpersonal bias is best illustrated by physician's treatment decisions based on racial prejudice and it's effect on African-Americans' health status. Institutional bias operates through organizational structures within an institution that "establishes separate and independent barriers" to health care services, which is best demonstrated by hospital closures in African-American communities. Finally, operating at a societal level, structural bias is the organizational structure of society, which privileges some groups, while denying others access to health care. An example of structural bias is the rationing of health care based on ability to pay rather than need. Seemingly similar, there is a significant difference between institutional and interpersonal bias versus structural bias. Both interpersonal and institutional biases focus on the direct racial effects of individual or institutional actions, whereas structural bias measures how non-race based factors, such as economic inequalities, indirectly affect racial minorities (Grant-Thomas and Powell, 2006).
We aimed to evaluate whether military service and access to veteran heath care coverage attenuates racial/ethnic disparities in time to mental health treatment initiation for posttraumatic stress disorder (PTSD), major depressive disorder, and/or alcohol-use disorder. Results are based on 13,528 civilians and 1,392 veterans from NESARC-III. Among civilians, racial/ethnic minorities reported longer time to PTSD and depression treatment initiation than non-Hispanic whites. Among veterans, racial/ethnic minorities did not differ from whites in time to PTSD and depression treatment initiation, and showed shorter time to treatment initiation for alcohol-use disorder treatment. Racial/ethnic minorities with past year veteran health care coverage showed the strongest evidence for attenuated disparities.
