Trends in Health Equity by Race/Ethnicity, Sex, and Income

MedicalResearch.com Interview with:

Frederick J. Zimmerman PhD Professor Department of Health Policy and Management & Center for Health Advancement UCLA Fielding School of Public Health

Dr. Zimmerman

Frederick J. Zimmerman PhD
Professor
Department of Health Policy and Management &
Center for Health Advancement
UCLA Fielding School of Public Health 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We’ve known that health equity is a priority, and we’ve known that we’re probably not doing well.  This new study quantifies the decline.

MedicalResearch.com: What should readers take away from your report? 

Response:  Looking at self-reported health status measures (general health and healthy days) from the Behavioral Risk Factor Surveillance System over 25 years, we found that while there have been small improvements in the disparities between White and African-American respondents over this period, several other measures of health equity show that we’re going backward.  In particular, while Black-White disparities slightly declined (0.5 standard deviations), income disparities increased markedly (1.5 SD) and a concept of Health Justice declines by 2 standard deviations over the 25 years.  An overall measure of health equity that integrates all of these perspectives was stagnant (self-reported general health) or declined by 1.0 standard deviations (healthy days).

While Black-White disparities have improved modestly since 1993, these gains have been more than wiped out by increasing income disparities in health. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: If we want serious progress on health equity, we need serious research on its causes.  That means tracking a single measure of health equity over time and across places to see what works and what doesn’t to improve performance in health equity.  

  • I’d like to acknowledge the generous support of the Robert Wood Johnson Foundations uclafsphfor partial funding for this research. 

Citation:

Zimmerman FJ, Anderson NW. Trends in Health Equity in the United States by Race/Ethnicity, Sex, and Income, 1993-2017. JAMA Netw Open. Published online June 28, 20192(6):e196386. doi:10.1001/jamanetworkopen.2019.6386

 

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Smoking Highlights Health Disparities Among US Cities

MedicalResearch.com Interview with:

Eric Leas PhD, MPH Stanford Prevention Research Center University of California, San Diego

Dr. Leas

Eric Leas PhD, MPH
Stanford Prevention Research Center
University of California, San Diego

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Recent research has demonstrated the importance that neighborhood context has on life opportunity, health and well-being that can perpetuate across generations. A strongly defining factor that leads to differences in health outcomes across neighborhoods, such as differences in chronic disease, is the concurrent-uneven distribution of modifiable risk factors for chronic disease.

The main goal of our study was to characterize inequities in smoking, the leading risk factor for chronic disease, between neighborhoods in America’s 500 largest cities. To accomplish this aim we used first-of-its-kind data generated from the 500 Cities Project—a collaboration between Robert Wood Johnson Foundation and the US Centers for Disease Control and Prevention—representing the largest effort to provide small-area estimates of modifiable risk factors for chronic disease.

We found that inequities in smoking prevalence are greater within cities than between cities, are highest in the nation’s capital, and are linked to inequities in chronic disease outcomes. We also found that inequities in smoking were associated to inequities in neighborhood characteristics, including race, median household income and the number of tobacco retailers. 

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Comparison of Local Public Health Departments Highlights Social Inequities

MedicalResearch.com Interview with:

Megan Wallace, DrPH Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland

Dr. Wallace

Megan Wallace, DrPH
Department of Epidemiology
Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Local health departments are often evaluated on a nationwide or statewide basis, however, given diversity among counties that exists even at the state level, we felt there might be a better way to group health departments for evaluation.

In this study, we created county-level clusters using local characteristics most associated with the outcomes of interest, which were smoking, motor vehicle crash deaths, and obesity. We then compared county-level percentile rankings for the outcomes within sociodemographic peer clusters vs nationwide rankings. We identified 8 groups of counties with similar local characteristics.

Percentile ranks for the outcomes of interest often differed when counties were compared within their peer groups in comparison with a nationwide scale.  Continue reading

Financial Savvy Linked To Better Later Life Outcomes

MedicalResearch.com Interview with:

Bryan D. James, PhD Assistant Professor Rush Alzheimer's Disease Center Chicago, IL 60612

Dr. James

Bryan D. James, PhD
Assistant Professor
Rush Alzheimer’s Disease Center
Chicago, IL 60612

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study is part of a larger body of research examining how literacy and decision making abilities in different areas of life can affect the health and well-being of older adults.

The main finding of this study is that a better ability to understand and utilize financial concepts was related to a lower risk of hospitalization in old age.

Over almost 2 years of follow-up, 30 percent of the 388 older men and women in this study were hospitalized at least once. A 4-point higher score on the scale of financial literacy, representing one standard deviation, was associated with about a 35 percent lower risk of hospitalization. This was after adjusting for a number of factors including physical and mental health indicators and income. The association appeared to be stronger for knowledge of financial concepts such as stocks and bonds, as opposed to the ability to perform numerical calculations. Additionally, the association was stronger for elective hospital admissions as opposed to emergency or urgent hospitalizations; this may support the notion that financial literacy is related to medical decision-making surrounding the decision to be hospitalized, such as which procedures are covered by Medicare.

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Cancer Death Rates Higher in Rural America

MedicalResearch.com Interview with:

Lisa C. Richardson, MD, MPH, Oncologist Director,Division of Cancer Prevention and Control CDC

Dr. Richardson

Lisa C. Richardson, MD, MPH, Oncologist
Director,Division of Cancer Prevention and Control
CDC

MedicalResearch.com: What is the background for this study?

Response: This MMWR report is the first complete description of cancer incidence and mortality comparing rural and urban America.  From previous reports we know that rural residents are more likely to be older, have more comorbid conditions and participate in high risk behaviors that can lead to cancer. CDC researchers were interested in how these factors were related to new cancers and cancer deaths in rural counties compared to metropolitan counties.

Researchers found that rates of new cases for lung cancer, colorectal cancer, and cervical cancer were higher in rural America. In contrast, rural areas were found to have lower rates of new cancers of the female breast, and prostate. Rural counties had higher death rates from lung, colorectal, prostate, and cervical cancers.

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Breast Cancer: Black Patients Had Fewer Sentinel Lymph Node Biopsies

Dalliah Black, MD F.A.C.S. Department of Surgical Oncology The University of Texas MD Anderson Cancer Center, HoustonMedicalResearch.com Interview with:
Dalliah Black, MD F.A.C.S.

Department of Surgical Oncology
The University of Texas
MD Anderson Cancer Center, Houston

 

MedicalResearch: What are the main findings of the study?

Dr. Black: This is a retrospective study from 2002 – 2007 using the SEER/Medicare database of over 31,000 women with node negative breast cancer evaluating the utilization of sentinel node biopsy (SNB) as it transitioned from an optional method for axillary staging to the standard of care instead of complete axillary lymph node dissection (ALND).  We found that SNB use increased each year in both white and black breast cancer patients throughout the study period.  However, SNB was less often performed in black patients (62.4%)compared to white patients (73.7%) and this disparity persisted through 2007 with a 12% difference.  Appropriate black patients more often had an ALND instead of the minimally invasive sentinel node biopsy which resulted in worse patient outcomes with higher lymphedema rates in black patients.  However, when black patients received the minimally invasive SNB, their rates of lymphedema were low and comparable to white patients who received SNB.
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HIV Care Gaps Largest among African Americans and Young People

MedicalResearch.com Interview with Dr. H. Irene Hall, PhD
Division of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention,
CDC
1600 Clifton Road, MS E-47, Atlanta, GA 30333

MedicalResearch.com: What are the main findings of the study?

Dr. Hall: Our research finds that, across all populations, far too few Americans with HIV receive the care they need to stay healthy and reduce risk of transmission. According to our research, gaps in care are the largest among African Americans and young people. Moving forward, improving care for all HIV-infected people will be critical to achieving the goal of an AIDS-free generation in America.

More specifically, some of the key findings of the study include:

  • Overall, only a quarter of all Americans with HIV have a suppressed viral load – meaning the level of HIV in their bodies is low enough to stay healthy and dramatically reduce the chance of transmitting to others.
  • By race/ethnicity, African-Americans and Hispanics or Latinos are less likely to be aware of their infection compared to whites.
  •  By age, younger Americans are less likely to be in ongoing care and have a suppressed viral load; HIV care and viral suppression generally improved with age. For example:
  • Fifteen percent of those aged 25-34 were virally suppressed, compared to 36 percent of those aged 55-64.
  • In terms of ongoing care, 28 percent of those 25-34 years old were retained in care, compared to 46 percent of those aged 55-64.
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