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Kaiser Health Disparities Report: A Weekly Look at Race, Ethnicity and Health




Monday, April 27, 2009 Thru Friday, May 1, 2009

















1.  Experts Raise Concern Over Cutting Nonemergency Health Services for Undocumented Immigrants

Several officials and experts have raised concern over some California counties' decision to cut certain nonemergency health services to undocumented immigrants, saying the move only shifts costs to emergency departments, the Los Angeles Times reports. Counties have been taking such action amid the current recession as a means to reduce their budgets.

In February, Sacramento County voted to prohibit undocumented immigrants from receiving care at county clinics to save an estimated $2.4 million. Contra Costa County last month cut services for undocumented adults, seeking to save an estimated $6 million. The move does not affect services for undocumented children and pregnant women. Yolo County will vote on a similar measure next month, which officials expect to affect 1,200 undocumented immigrants and reduce spending by $1.2 million.
Robert Pestronk, executive director of the National Association of County and City Health Officials, said, "This is a balloon that just expands. If you squeeze it in one place, it's just going to expand somewhere else." David Hayes-Bautista, professor of medicine and director of the University of California-Los Angeles' Center for the Study of Latino Health and Culture, said cutting services is not a long-term solution for managing county budgets.

Reshma Shamasunder, director of the California Immigrant Policy Center, added that denying health care for a particular segment of the population puts others at risk for communicable diseases that have been left untreated and causes ED overcrowding. Soren Tjernell of the Community Clinic Consortium, which represents clinics in Contra Costa and Solano counties, said, "Except by helping us balance the budget, it doesn't help us, it doesn't help our citizens, it doesn't help our undocumented," adding, "But if we don't have the money, we just can't afford it" (Gorman, Los Angeles Times, 4/27).

2.  Blacks Will Likely Be Negatively Affected by Proposed Medicare Reimbursement Change for Dialysis Treatment, Study Finds

Black dialysis patients might be negatively affected by proposed changes in Medicare reimbursement policy, according to a study published in the Journal of the American Society of Nephrology, Reuters Health reports. CMS has proposed making one lump payment to cover both dialysis and injectable medications, instead of continuing to reimburse the procedures separately.

For the study, lead researcher Areef Ishani of the University of Minnesota and colleagues calculated the effect of the proposal on a representative cohort of 12,000 patients who started hemodialysis when they were age 67 or older. Researchers found that based on existing CMS data, blacks have lower initial levels of red blood cells than whites and require higher doses of epo-type drugs to achieve similar hemoglobin levels. As a result, blacks require on average 11% more epo per month than whites during the first two months on dialysis.

Researchers contend that because blacks required higher doses of the costly drugs, facilities might be biased against treating them, Reuters Health reports. The researchers concluded, "Costs of providing dialysis care could be higher than reimbursement rates, possibly creating a disincentive to treat [blacks], and thus difficulties gaining access to care" (Reuters Health, 4/30).

An abstract of the study is available online.


3.  Low-Income, Minority Communities Disproportionately Exposed to Toxic Air Pollutants, Study Finds

Low-income and minority neighborhoods are disproportionately affected by harmful and possible carcinogenic air pollutants, according to a study released on Tuesday by researchers from the University of Massachusetts and the University of Southern California, the Milwaukee Journal Sentinel reports.

The study, funded by the Ford Foundation, is based on 2005 data from 300 metropolitan areas and ranks the cities based on how pollution affects low-income and minority neighborhoods. Much of the data came from the federal government's toxics release inventory, which requires the reporting of emissions of hundreds of chemicals.

Birmingham, Ala. -- which has heavy steel manufacturing and metal industries -- ranked first in both measures, and Baton Rouge, La. -- which has a large petrochemical center -- ranked second. Residential areas near such factories tend to have lower economic value, and many low-income and minority individuals live in the communities, researchers said.

Researchers noted that while the emissions from the factories were within federal standards, the findings indicate that minorities and the poor often face substantial exposure to environmental toxins, which can cause certain health conditions. According to the Journal Sentinel, the study is one of the first efforts to "correlate toxic emissions from factories with the ethnic and economic makeup of areas around them" and also "underscores the notion that pollution has a racial and economic dimension" (Bergquist, Milwaukee Journal Sentinel, 4/28).

Michael Ash, associate professor of economics and public policy at the University of Massachusetts, said, "We really see that being on the wrong side of the environmental tracks applies to both low-income populations and minority populations. ... This type of information may be useful for community shareholders and community activists" (Lynch, Detroit News, 4/28).

The report is available online (.pdf).

4.  Elderly, Minorities To Be Affected by Expected Increase in Cancer Diagnoses Over Next Two Decades, Study Predicts

Over the next 20 years, the number of new cancer cases diagnosed annually will increase by 45%, and minorities and older adults -- segments of the population expected to grow rapidly -- will be disproportionately affected, according to a study released on Wednesday and published in the Journal of Clinical Oncology, Reuters Health reports.

For the study, researcher Ben Smith of the University of Texas M.D. Anderson Cancer Center and colleagues examined current U.S. Census Bureau statistics and cancer rates to look at how changes in the population will affect the number of people diagnosed with cancer. The data assume that rates of cancer would remain about the same. "This is basically [showing] how ... our population changes impact the number of people getting cancer," Smith added, noting, "Both older adults and minorities are segments of the patient population that are particularly vulnerable to receiving sub-optimal medical care."

Researchers projected a 67% increase in the number of adults ages 65 and older diagnosed with cancer in 2030. Researchers also project that by 2030, the number of cancer cases annually among minorities will double from 330,000 to 660,000.

"In 2030, 70% of all cancers will be diagnosed in the elderly and 28% in minorities, and the number of older adults diagnosed with cancer will be the same as the total number of Americans diagnosed with cancer in 2010," Smith said (Steenhuysen, Reuters Health, 4/29).

An abstract of the study is available online.


5.  Many Low-Income, Minority Adults With Type 2 Diabetes Not Knowledgeable of the Condition, Study Finds

Many low-income minority adults with type 2 diabetes have misconceptions about the disease that could affect its management, according to a study published in the journal Diabetes Care, Reuters Health reports. For the study, researcher Devin Mann of Mount Sinai School of Medicine and colleagues surveyed 151 people who, on average, had diabetes for 13 years and were receiving routine medical care. Fifty-eight percent of respondents were Hispanics and 34% were black. Most of the participants had annual incomes below $30,000.

About one in three of respondents believed that their doctor could cure their condition or that they would not always have the disease, and most were unaware of the hemoglobin A1C test, which is used to gauge long-term blood glucose control, according to the study. Among the respondents, researchers also found that:

  • 56% believed that normal blood glucose levels were 200 milligrams per deciliter of blood or less, when in fact normal levels are below 100 mg/dL for fasting blood glucose or below 140 mg/dL after an oral glucose tolerance test;

  • 42% said that glucose levels of 110 mg/dL or less were too low;

  • 54% said they could feel when their blood glucose levels were too high; and

  • 55% of those using insulin were more likely to have misconceptions, as were the 25% whose A1C levels signaled poor blood glucose control.

Mann said, "The newly observed misconceptions and related predictors may represent important opportunities for targeting barriers to successful diabetes management" (Reuters Health, 4/28).

An abstract of the study is available online.

6.  'Avoidable' Deaths Account for Large Part of Black, White Mortality Gap, Study Finds

Preventable or treatable deaths contribute to a large portion of the mortality gap between blacks and whites, according to a study published in the Journal of Epidemiology and Community, the Chicago Sun-Times reports. For the study, researcher James Macinko of the University of Pennsylvania and colleagues looked at diabetes, stroke, infectious and respiratory diseases, preventable cancers and circulatory diseases such as high-blood pressure (Chicago Sun-Times, 4/27).

Deaths from such preventable or treatable conditions -- or "avoidable mortality," which is defined as death under age 65 from conditions responsive to medical care, changes in public policy or behaviors -- accounted for nearly 70% of the black-white mortality gap from 1980 to 2005, researchers said. Avoidable death represented about 30% of the gap for men and 42% for women.

Macinko said in a statement, "Our study shows that while much progress has been made, our health care system is still failing to meet the very basic needs of some Americans. Many disparities can be conquered by focusing more on public policies that promote prevention and by ensuring that all Americans have access to good quality health care." He added, "People should not be dying prematurely from stroke, hypertension, diabetes, colon cancer, appendicitis or the flu" (United Press International, 4/27).

An abstract of the study is available online.


7.  Arizona Republic Examines Dentist Shortage, Recruitment Efforts in American Indian Communities

The Arizona Republic on Monday examined efforts to boost the number of American Indians in health professions, particularly dental care. There are fewer than 150 American Indian dentists in the U.S., or about one for every 32,000 American Indians, Carol Grant, director of American Indian Health Professions at A.T. Still University, said.

In addition, a report released in 2000 by the American Dental Association found that tooth-decay rates are four times higher among American Indian children than the general population, Frank Ayers, dean of student affairs at Creighton University's School of Dentistry, said. The key to addressing such disparities is to recruit dental students from the American Indian community, he added. "If a student has a strong tribal affiliation when you bring them into the profession, they are much more likely to return to the reservation and help their people," Ayers said. Only about 30 American Indian students on average enroll in dental schools each year, according to Ayers.

George Blue Spruce, the nation's first American Indian dentist and an assistant dean at the university, travels across the country encouraging young American Indians to pursue careers in health care. A.T. Still University has more American Indian dentists in training than any other school in the country, mostly because of Blue Spruce's efforts, according to the Republic.

The school also is training American Indians in osteopathic medicine and as physician assistants and athletic trainers (Hermann, Arizona Republic, 4/27).


8.  Connecticut Hospital Association Partners with NAACP, Makes Other Efforts To Reduce Racial Health Disparities

The Connecticut Hospital Association's board of trustees recently approved a plan that aims to reduce racial health disparities, the Meriden Record-Journal reports. Three main goals of the effort are to increase minority representation in hospital leadership, expand business opportunities with minority businesses and reduce barriers to health care, Leslie Gianelli, the association's director of communications and public affairs, said.

As part of the plan, CHA has partnered with the state chapter of the National Association for the Advancement of Colored People to improve minority leadership opportunities on hospital boards and in other roles, and to support post-graduate training for hospital management positions. CHA plans to partner with other organizations in the future, Gianelli said.

The plan also aims to reduce disparities in treatment among minority populations experiencing disproportionately high incidences of premature births, low birthweight infants, asthma and diabetes. The plan also calls for improving Medicaid reimbursement rates and access to primary care services. Jennifer Jackson, the association's CEO, said the next step will be establishing measurable goals for their efforts (Kurz, Meriden Record-Journal, 4/26).

9.  Texas Effort To Examine Alzheimer's Disease Among Hispanics

The Texas Alzheimer's Research Consortium on Wednesday announced a new effort that seeks to study Alzheimer's disease among Hispanics, the AP/Dallas Morning News reports. "Hispanics are underrepresented nationally in Alzheimer's research, [and] we have an opportunity in Texas to lead the country in this work," Rachelle Doody, a neurology professor at Baylor College of Medicine, said.

Baylor College of Medicine, the Texas Tech University Health Sciences Center, the University of North Texas Health Science Center, the University of Texas Southwestern Medical Center and University of Texas-San Antonio Health Science Center are members of the consortium.

The group has created a "bio-bank" of blood tissue data for future research and clinical, psychological and lab data on 800 research participants, according to the Morning News. The new project will recruit volunteers from an ongoing heart and aging study in San Antonio.

Researchers have historical data on that group's diabetes and cardiovascular risks, Donald Royall, chief of aging and geriatric psychiatry at University of Texas-San Antonio Health Science Center, said. According to researchers, Hispanics have high rates of diabetes and heart disease, which both have recently been linked to the onset of Alzheimer's (Vertuno, AP/Dallas Morning News, 4/29).

10.  Efforts, Events Seek To Address Health Disparities Among Minorities

The following highlights efforts that seek to reduce racial and ethnic health disparities.

  • American Society of Clinical Oncology: ASCO on Wednesday released a policy statement that makes recommendations for eliminating cancer disparities. The statement, which was published in the Journal of Clinical Oncology, recommends increasing research, boosting enrollment of minorities in cancer clinical trials, encouraging greater diversity in the oncology workforce, educating the oncology workforce about cultural issues and disparities and ensuring equal access to quality health care. ASCO also announced the 2009 recipients of its Diversity in Oncology Initiative awards, a program in partnership with Susan G. Komen for the Cure that aims to reduce health care disparities by boosting the number of minority oncologists (ASCO release, 4/29).

  • Detroit: Gospel music artist Yolanda Adams, through a partnership with AARP and Radio One, recently stopped in Detroit for a Health & Wellness tour, which aims to encourage healthy living in the black community, the Detroit News reports. The event included no-cost health screenings and seminars. Adams also targets the black religious community with health messages through her nationally syndicated radio show (Hayes Taylor, Detroit News, 4/24).

  • National Minority Quality Forum: NMQF has announced that it is launching a database that tracks cardiovascular disease nationwide, called CVD Atlas. CVD Atlas, which is a component of an existing database by NMQF, enables users to map the prevalence of CVD by state, legislative district, age, gender, race and ethnicity. The American College of Cardiology and Novartis Pharmaceuticals Corporation both support the system (NMQF release, 4/27).


11.  Parents Should 'Take Immediate Action' To Address Obesity Among Young Children, Editorial States

"All parents, regardless of race, should be alarmed" by the recent finding that
"[m]ore than half a million 4-year-olds are obese, and [that] the numbers are even more startling among children of color," a Philadelphia Inquirer editorial states (Philadelphia Inquirer, 4/25). The study, published this month in the Archives of Pediatrics & Adolescent Medicine, found that 31% of American Indian children, 22% of Hispanic children, nearly 21% of black children, 16% of white children and 13% of Asian children were obese (Kaiser Health Disparities Report, 4/25).

The "study did not explore reasons for the racial disparity. But other research has shown that minorities are at a higher risk of obesity because they generally live in poor households, eat diets high in fat and calories, and have less-educated parents," according to the Inquirer. "The differences by race at such an early age surprised researchers," the editorial adds, noting that the "study is believed to be the first analysis of national obesity rates in preschool kids in the nation's five major ethnic or racial groups."

Parents should "take immediate action to put their children on a healthier track. That means providing kids with more nutritious meal choices, limiting junk food and encouraging them to exercise more than their fingers punching a computer game's keypad," the editorial concludes (Philadelphia Inquirer, 4/25).


12.  Kaiser Family Foundation Releases Survey About HIV/AIDS in U.S.

"2009 Survey of Americans on HIV/AIDS," Kaiser Family Foundation: The new survey found that in the U.S., the sense of urgency about HIV/AIDS as a national health issue has decreased significantly and that residents' concerns about the disease as a personal risk also has declined, even among some high-risk groups. According to the survey, the percentage of people in the U.S. who named HIV/AIDS as the most urgent health problem facing the country decreased from 44% in 1995 to 17% in 2006 and 6% currently. It also found that although blacks and Hispanics have HIV rates seven and three times higher than whites, respectively, and are more likely to see HIV/AIDS as a pressing issue, fewer say that it is a "more urgent" problem now than in 2006. According to the survey, the percentage of people ages 18 to 29 who say that they are personally very concerned about contracting HIV decreased from 30% in 1997 to 17% currently. In addition, it found that 53% of non-elderly adults say that they have been tested for HIV. Half of the U.S. public thinks that the federal government is allocating too little on domestic HIV/AIDS issues, and the survey also found signs that HIV/AIDS might carry less stigma than in the past (Kaiser Family Foundation release, 4/28).
Kaiser Health Disparities Report: A Weekly Look At Race, Ethnicity And Health
The Kaiser Health Disparities Report is published for, a website of the Kaiser Family Foundation. (c) 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

policy research, analyses, reports and fact sheets, and media partnerships, visit the Foundation's main website at

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