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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The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Why Do 700 US Women Die of Pregnancy-Related Causes Each Year?

MedicalResearch.com Interview with:

Emily Petersen, MD.Lead for the Pregnancy Mortality Surveillance SystemDivision of Reproductive Health

Dr. Peterson

Emily Petersen, MD.
Lead for the Pregnancy Mortality Surveillance System
Division of Reproductive Health  

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

Response: About 700 women die of pregnancy-related causes each year in the United States. The new analysis provides much-needed perspective on the circumstances surrounding pregnancy-related deaths and summarizes potential strategies to prevent future deaths.

Continue reading

How Did Medicaid Expansion Affect Low Birth Weights and Preterm Births?

MedicalResearch.com Interview with:

Clare Brown, PhDHealth Systems and Services ResearchUniversity of Arkansas for Medical Sciences

Dr. Brown

Clare Brown, PhD
Health Systems and Services Research
University of Arkansas for Medical Sciences

J. Mick Tilford, PhD, Professor and ChairDepartment of Health Policy and ManagementFay W. Boozman College of Public HealthUniversity of Arkansas for Medical Science

Dr. Tilford

J. Mick Tilford, PhD,
Professor and Chair

Department of Health Policy and Management
Fay W. Boozman College of Public Health
University of Arkansas for Medical Science

 

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

Response: Prematurity and low birthweight are associated with increased risk of infant mortality as well as increased risk of chronic conditions throughout infancy and into adulthood. Non-Hispanic black infants are twice as likely to be born low birthweight (13.9% vs 7.0%) and 1.5 times as likely to be born prematurely (13.9% vs 9.1%) compared to non-Hispanic white infants.

Under the Affordable Care Act (ACA), states may expand Medicaid to adults with household income levels at or below 138% of the federal poverty level, thus extending coverage to childless adults and improving continuity. Insurance gain may ultimately improve maternal health, increased use and earlier initiation of prenatal care services, and improved access to pregnancy planning resources.

Our study aimed to evaluate whether there were changes in rates of low birthweight and preterm birth outcomes among states that expanded Medicaid versus states that did not expand Medicaid. Continue reading

Pediatric Melanoma Risk Increasing in Adolescents & Young Adults, Including in Non-Whites

MedicalResearch.com Interview with:

Susan M. Swetter, MDProfessor of DermatologyDirector, Pigmented Lesion & Melanoma ProgramPhysician Leader, Cancer Care Program in Cutaneous OncologyStanford University Medical Center and Cancer Institute

Dr. Swetter

Susan M. Swetter, MD
Professor of Dermatology
Director, Pigmented Lesion & Melanoma Program
Physician Leader, Cancer Care Program in Cutaneous Oncology
Stanford University Medical Center and Cancer Institute

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

Response: The Stanford Pigmented Lesion and Melanoma and Program and Pediatric Dermatology Division participated in the long-term management of children, adolescents and young adults (<25 years of age) with melanoma and atypical melanocytic neoplasms, including atypical Spitz tumors (ASTs) that may be histopathologically challenging to differentiate from true melanoma.

Over a 23-year period, we have observed increased racial-ethnic diversity in young patients with these diagnoses, especially in the presentation of young individuals with darker skin phenotypes and more clinically amelanotic (nonpigmented) lesions compared to patients with lighter skin.  Continue reading

Cervical Cancer Subtypes Vary Among Population Sectors

MedicalResearch.com Interview with:

Farhad Islami, MD PhD Scientific Director, Surveillance Research American Cancer Society, Inc. Atlanta, GA 30303

Dr. Islami

Farhad Islami, MD PhD
Scientific Director, Surveillance Research
American Cancer Society, Inc.
Atlanta, GA 30303 

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

Response: Despite a continuous decline in cervical cancer incidence rates, earlier studies reported an increase in cervical adenocarcinoma incidence rates. However, those reports had major limitations, as they did not account for changes in hysterectomy prevalence and used cancer occurrence data covering only 10%-12% of the U.S. population (which may not be representative of the entire population, especially racial/ethnic minorities).

Further, the most recent study examined the trends by age and histology through 2010. We examined contemporary trends in cervical cancer incidence rates in the U.S. (1999-2015) by age, race/ethnicity, major histological subtypes, and stage at diagnosis using up-to-date nationwide data after accounting for hysterectomy prevalence.

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Racial Disparities in Kidney Transplants Persist Despite New Allocation System

MedicalResearch.com Interview with:

Sanjay Kulkarni, MD MHCM FACSAssociate Professor of Surgery & MedicineSurgical Director – Kidney Transplant ProgramMedical Director – Center for Living Organ DonorsScientific Director – Yale Transplant ResearchNew Haven, CT 06410

Dr. Kulkarni

Sanjay Kulkarni, MD MHCM FACS
Associate Professor of Surgery & Medicine
Surgical Director – Kidney Transplant Program
Medical Director – Center for Living Organ Donors
Scientific Director – Yale Transplant Research
New Haven, CT 06410

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

Response: The kidney allocation system changed in December of 2014.

The aim of the new system was to increase transplant in patients who were highly sensitized (difficult matches based on reactive antibodies) and to improve access to underserved populations. Continue reading

Lack of HPV Vaccination in Young Minority Men Is Not a Matter of Access

MedicalResearch.com Interview with:
Perry N Halkitis, PhD, MS, MPH
Dean and Professor
Department of Urban-Global Public Health
Rutgers Public Health 

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

Response: The rate of human papillomavirus (HPV) infection is high among young minority gay, bisexual, and other men who have sex with men despite the availability of a vaccine that can prevent the infection, a Rutgers School of Public Health study found.

Continue reading

Study finds Value-Based Payment Program Did Not Harm African-American Patients In Terms of Mortality. 

MedicalResearch.com Interview with:

Teryl K. Nuckols, MDVice Chair, Clinical ResearchDirector, Division of General Internal MedicineCedars-Sinai Medical Center 

Dr. Nuckols

Teryl K. Nuckols, MD
Vice Chair, Clinical Research
Director, Division of General Internal Medicine
Cedars-Sinai Medical Center 

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

Response: Healthcare policymakers have long worried that value-based payment programs unfairly penalize hospitals treating many African-American patients, which could worsen health outcomes for this group.

For example, policy experts have suspected that the Medicare Hospital Readmission Reduction Program unevenly punishes institutions caring for more vulnerable populations, including racial minorities. They’ve also feared that hospitals might be incentivized to not give patients the care they need to avoid readmissions.

The study Investigators wanted to determine whether death rates following discharges increased among African-American and white patients 65 years and older after the Medicare Hospital Readmission Reduction Program started.

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Tooth Loss Linked To Greater Risk of Pancreatic Cancer Among African American Women

MedicalResearch.com Interview with:

Dr. Julie Palmer

Dr. Palmer

Julie R. Palmer, ScD
Professor, Boston University School of Medicine
Associate Director, Slone Epidemiology Center at Boston University
Boston, MA 02118 

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

Response: Since 1995, 59,000 African American women from all regions of the U.S. have participated in a Boston University research study of the health of Black women.  Study participants complete mailed or online questionnaires every two years.

Our major goal is to identify modifiable risk factors for cancers and nonmalignant conditions that disproportionately affect African Americans (e.g., pancreatic cancer, early-onset breast cancer, type 2 diabetes, uterine fibroids).  The reasons for the higher incidence of pancreatic cancer in African Americans relative to non-Hispanic White women in the U.S. are unknown.

I was aware that several recent studies in predominantly White populations had observed a higher incidence of pancreatic cancer in those who had reported poor oral health and wondered whether the higher prevalence of poor oral health among African Americans could play a role in their higher incidence of pancreatic cancer.  We had already asked about gum disease, periodontal disease, and adult tooth loss in several rounds of data collection.

After rigorous analysis, we found that women who reported any adult tooth loss had about two times the risk of future development of pancreatic cancer compared with those who had no tooth loss and had never reported periodontal disease.

The estimated risk was even greater for those who had lost five or more teeth. A similar association was observed for reports of periodontal disease, but the association was not statistically significant.

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Study Emphasizes Need to Establish Optimal Pressure Combination Therapies by Ethnicity

MedicalResearch.com Interview with:

Dike B. Ojji, M.D., Ph.D, FWACP, FACPDepartment of MedicineFaculty of Clinical SciencesUniversity of Abuja

Dr. Ojji

Dike B. Ojji, M.D., Ph.D, FWACP, FACP
Department of Medicine
Faculty of Clinical Sciences
University of Abuja

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

Response: We decided to do this research because there were no large RCTs before now that have compared the efficacy of contemporary combination therapies among any black populations in spite of the high burden of hypertension and its complications (such as heart failure, cerebrovascular accident and chronic kidney) in this population, and also the fact that majority require 2 or more medications to control their blood pressure.

Continue reading

African American Patients with Psoriasis at Even Greater Risk of Atherosclerotic Heart Disease

MedicalResearch.com Interview with:

Francis Alenghat, MD, PhD Assistant Professor of Medicine Section of Cardiology University of Chicago

Dr. Alenghat

Francis Alenghat, MD, PhD
Assistant Professor of Medicine
Section of Cardiology
University of Chicago

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

Response: Psoriasis has been associated with higher rates of atherosclerotic cardiovascular disease (ASCVD), potentially due to higher-than-normal levels of systemic inflammation. Whether this association varies by race was unknown. Also, it was unclear whether patients with psoriasis have more frequent ASCVD because of higher rates of traditional cardiovascular risk factors (smoking, diabetes, hypertension, hyperlipidemia) or because of components intrinsic to psoriasis itself.

We found that, amongst a large population of patients with psoriasis, patients of both sexes and most ages had elevated ASCVD rates compared to those without psoriasis. Overall, African American patients with psoriasis had a 15% ASCVD prevalence, whereas it was 10% in white patients with psoriasis. Increased ASCVD associated with psoriasis occurred at earlier ages in African American patients compared to white patients.

Traditional cardiovascular risk factors were common in patients with psoriasis and appeared to play a large role in the driving the higher rates of ASCVD in these patients, but even in patients with psoriasis but without any documented traditional risk factors, ASCVD rates were elevated compared to patients without psoriasis.  Continue reading

Transparency and Technology Reduced Racial Disparities in Early Lung Cancer Treatment

MedicalResearch.com Interview with:

Samuel Cykert, MD Professor of Medicine and Director of the Program on Health and Clinical Informatics UNC School of Medicine, and Associate Director for Medical Education, NC AHEC Program Chapel Hill, NC

Dr. Cykert

Samuel Cykert, MD
Professor of Medicine and Director of the Program on Health and Clinical Informatics
UNC School of Medicine, and
Associate Director for Medical Education, NC AHEC Program
Chapel Hill, NC

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

Response: Reports going as far back as the early 1990’s through reports published very recently show that Black patients with early stage, curable lung cancer are not treated with aggressive, curative treatments as often as White patients. These type of results have been shown in other cancers also. It’s particularly important for lung cancer because over 90% of these patients are  dead within 4 years if left untreated. In 2010, our group published a study in the Journal of the American Medical Association that showed that Black patients who had poor perceptions of communication (with their provider), who did not understand their prognosis with vs. without treatment, and who did not have a regular source of care ( a primary care doctor) were much less likely to get curative surgery. Also our results suggested that physicians who treated lung cancer seemed less willing to take the risk of aggressive treatments in treating Black patients (who they did not identify with as well) who had other significant illnesses.

Because of the persisting disparities and our 2010 findings, we worked with a community group, the Greensboro Health Disparities Collaborative to consider potential solutions.  As these omissions were not overt or intentional because of race on the part of the patients or doctors, we came up with the idea that we needed transparency to shine light on treatment that wasn’t progressing and better communication to ensure that patients were deciding on good information and not acting on mistrust or false beliefs.  We also felt the need for accountability – the care teams needed to know how things were going with patients and they needed to know this according to race. To meet these specifications, we designed a system that received data from electronic health records about patients’ scheduled appointments and procedures. If a patient missed an appointment this umbrella system triggered a warning. When a warning was triggered, a nurse navigator trained specially on communication issues, re-engaged the patient to bring him/her back into care. In the system, we also programmed the timing of expected milestones in care, and if these treatment milestones were not reached in the designated time frame, a physician leader would re-engage the clinical team to consider the care options.

Using this system that combined transparency through technology, essentially our real time warning registry, and humans who were accountable for the triggered warnings, care improved for both Black and White patients and the treatment disparity for Black patients was dramatically reduced. In terms of the numbers, at baseline, before the intervention, 79% of White patients completed treatment compared to 69% of Black patients. For the group who received the intervention, the rate of completed treatment for White patients was 95% and for Black patients 96.5%.  Continue reading

Program Addresses Racial Inequities in Breastfeeding in Southern US

MedicalResearch.com Interview with:

Dr-Anne Merewood

Dr. Merewood

Anne Merewood PhD MPH
Director, Center for Health Equity, Education, and Research
Associate Professor of Pediatrics, Boston University School of Medicine
Associate Professor of Community Health Sciences
Boston University School of Public Health

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

Response: CHAMPS (Communities and Hospitals Advancing Maternity Practices) worked with hospitals and communities across the southern US to implement the Baby-Friendly Hospital Initiative and decrease racial inequities in breastfeeding rates.

We found that indeed this program significantly reduced the gap between Black and White breastfeeding initiation rates in the 31 hospitals studied, by almost 10%. 

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

Response: Hospitals and communities can work together in areas where racial disparities are extreme and breastfeeding rates are low, to improve hospital practices around the time of birth. These changes will have an impact on racial gaps in breastfeeding, and will bring more humane and evidence-based care to thousands of women, now and in the future, as the changes are solidified. Improved practices level the playing field for underprivileged groups. 

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

Response: Future research should assess the implementation model to see if it can be applied in other settings. Also, future research needs to examine how well these changes can be sustained. 

Citation:

Addressing Racial Inequities in Breastfeeding in the Southern United States

Anne Merewood, Kimarie Bugg, Laura Burnham, Kirsten Krane, Nathan Nickel, Sarah Broom, Roger Edwards, Lori Feldman-Winter
Pediatrics Jan 2019, e20181897; DOI: 10.1542/peds.2018-1897

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The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Racial and Gender Disparities in Stroke Risks

MedicalResearch.com Interview with:

Virginia J. Howard,PhD, FAHA, FSCT   
 Professor of Epidemiology
The University of Alabama at Birmingham

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

Response: This study comes from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national cohort study of 30,239 non-Hispanic black and white community-dwelling participants aged 45 years and older who lived in the 48 contiguous US states. 

REGARDS was designed to study risk factors for the development of stroke, with a focus on black and white comparisons as well as comparisons across geographic regions of the US.

Continue reading

Black Mothers More Likely To Think Their Sons Have ADHD

MedicalResearch.com Interview with:

George J. DuPaul, PhD Department of Education and Human Services Lehigh University

Dr. DuPaul


George J. DuPaul, PhD

Department of Education and Human Services
Lehigh University

Charles Barrett. Ph.D. School Psychologist Lehigh University

Dr. Barrett

 

Charles Barrett. Ph.D.
School Psychologist
Loudon County Virginia
Public Schools

 

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

Response: Numerous studies have shown that Black children are more likely to receive ratings that are more indicative of displaying externalizing behavior difficulties, including Attention Deficit Hyperactivity Disorder (ADHD).  However, many of these studies included teachers as the informants. Consistent with most teachers in the United States, raters have typically been White females.  For this reason, it is unclear if these outcomes would exist if the rater and child shared the same racial/ethnic background. Additionally, most research in the United States that involved cross-cultural comparisons has used White and Hispanic boys.  Few empirical studies have examined differences between Black and White boys.

The present study sought to address several limitations in the field.  Most notably, cross-cultural comparisons between Black and White boys were included instead of Hispanic and White children.  Next, maternal figures, rather than teachers, were included as the informants.

The present study was developed using a similar methodology that examined Hispanic and White boys’ behavior from the perspective of Hispanic and White teachers (Dominguez de Ramirez & Shapiro, 2005). In sum, we sought to determine if there were differences in how Black and White maternal figures rated Black and White boys who were demonstrating the same level/type of behavior (i.e., sub-clinical levels of ADHD).  Notably, although the boys’ behaviors were the same, maternal ratings were not identical.

Specifically, using the ADHD Rating Scale, Fourth Edition (ARS-4), Black mothers assigned higher ratings to both Black and White boys.

Continue reading

MidLife PSA Can Risk-Stratify Prostate Cancer in African American Men

MedicalResearch.com Interview with:

Mark Preston, MD, MPH Associate Surgeon, Brigham and Women's Hospital Assistant Professor of Surgery, Harvard Medical School Brigham and Women's Hospital Department of Surgery, Urology Boston, MA

Dr. Preston

Mark Preston, MD, MPH
Associate Surgeon, Brigham and Women’s Hospital
Assistant Professor of Surgery, Harvard Medical School
Brigham and Women’s Hospital
Department of Surgery, Urology
Boston, MA
MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Black men are at significantly increased risk of developing and dying from prostate cancer. Unfortunately, there is limited research on screening strategies in this high-risk population. In this original investigation, we studied how baseline PSA levels measured in midlife predict later risk of aggressive prostate cancer in a population of black men. This study used stored blood samples and over a decade of follow-up in the Southern Community Cohort Study, an on-going cohort study with the highest representation of black men in the U.S.

We demonstrated that PSA levels in midlife very strongly predict future aggressive prostate cancer. Our data identify subgroups of black men who have widely divergent long-term risk of aggressive prostate cancer based on baseline PSA during midlife. We suggest that these groups could benefit from screening intervals tailored to their actual magnitude of disease risk.

These important findings build on our previous work on baseline PSA and subsequent risk of lethal prostate cancer in mainly white men, which was published in the Journal of Clinical Oncology in August 2016. 

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

Response: One strategy for improving PSA screening is to do an earlier measurement of PSA during midlife (aged 40-55). PSA levels during midlife have been shown by our group and others to strongly predict long-term risk of prostate cancer, particularly risk of aggressive disease, in now both black and white men.

This baseline PSA level during midlife can be used to risk-stratify PSA screening, targeting higher risk men for screening in order to diagnosis and treat them early while an opportunity exists for cure.  In addition, men at low risk could safely be screened less frequently. As a result, much of the benefit of PSA screening on prostate cancer mortality could be maintained, while overdiagnosis and overtreatment would be reduced.

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

Response: Prospective studies of a risk stratified screening program should be conducted.  We are also studying ways to further improve risk prediction and to explore biologic mechanisms why a midlife PSA is so predictive.

Disclosures. I have no disclosures. Disclosures for other authors are listed in the manuscript.

Citation:

Eur Urol. 2018 Sep 17. pii: S0302-2838(18)30627-4. doi: 10.1016/j.eururo.2018.08.032. [Epub ahead of print]

Baseline Prostate-specific Antigen Level in Midlife and Aggressive Prostate Cancer in Black Men.

Preston MA1, Gerke T2, Carlsson SV3, Signorello L4, Sjoberg DD5, Markt SC6, Kibel AS7, Trinh QD7, Steinwandel M8, Blot W9, Vickers AJ5, Lilja H10, Mucci LA6, Wilson KM11.

[last-modified]

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Black-White Hypertension Divide: Is The Southern Diet a Culprit?

MedicalResearch.com Interview with:

Dr. George Howard DPH, for the research team Professor and Chair of Biostatistics University of Alabama at Birmingham

Dr. Howard

Dr. George Howard DPH, for the research team
Professor and Chair of Biostatistics
University of Alabama at Birmingham

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

Response: Perhaps the most important distinction to draw for the readers is that this is not a paper about risk factors for hypertension, but rather a paper that looks for contributors to the black-white difference in the presence of hypertension.  This racial difference in hypertension is the single biggest contributor to the immense disparities in cardiovascular diseases (stroke, MI, etc.) that underpin the approximate 4-year difference in black-white life expectancy.  As such, this work is “going back upstream” to understand the causes that lead to blacks having a higher prevalence of hypertension than whites with hopes that changing this difference will lead to reductions in the black-white disparities in cardiovascular diseases and life expectancy.   This difference in the prevalence of hypertension is immense … in our national study of people over age 45, about 50% of whites have hypertension compared to about 70% of blacks … that is HUGE.   We think that changing this difference is (at least one of) the “holy grail” of disparities research.

This study demonstrates that there are several “targets” where changes could be made to reduce the black-white difference in hypertension, and thereby the black-white difference in cardiovascular diseases and life expectancy; however, the most “potent” of these appears to be diet changes.   Even though we know what foods promote a heart healthy lifestyle, we still have major differences in terms of how that message is being adopted by various groups of Americans.  We can’t know from our data what about the Southern diet is driving these racial differences in hypertension but we can begin to design community based interventions that could possibly help to reduce these racial disparities through diet.  It is interested that diet more than being overweight was the biggest contributor to the racial disparities in hypertension.  This would suggest we might want to consider interventions to increase health foods in the diet while minimizing fried foods and processed meats.

While this is not a clinical trial that “proves” that changes in diet will reduce the disparity in blood pressure, we consider the “message” of the paper to be good news, as the things that we found that contribute to this black-white difference are things that can be changed.   While it is always hard for individual people to change their diet, it can be done.   More importantly, over time we as a society have been changing what we eat … but we need to “double down” and try to change this faster.   Also, policy changes of play a role to gently make changes in these diet, where for example Great Britain has been making policy changes to slowly remove salt from the diet.   These changes are possible … and as such, we may see a day when the black-white differences in hypertension (and thereby CVD and death) may be reduced. 

Continue reading

Dermatology Care Varies Widely by Gender, Socioeconomic Factors and Race

MedicalResearch.com Interview with:

Raghav Tripathi, MPH Case Western Reserve University MD Candidate, Class of 2021

Raghav Tripathi

Raghav Tripathi, MPH
Case Western Reserve University
MD Candidate, Class of 2021

MedicalResearch.com: Why did you decide to perform this study?

Response: Differences in the impact of dermatologic conditions on different groups have been of interest to our research group for a long time. Previously, our group had found differences in time to treatment for patients with different skin cancers. Beyond this, we had found differences in mortality and incidence of various skin conditions (controlling for other factors) in different racial groups/ethnicities, socioeconomic groups, demographic groups, and across the rural-urban continuum.

The goal of this study was to investigate socioeconomic and demographic differences in utilization of outpatient dermatologic care across the United States. As demographics throughout the country become more diverse, understanding differences in utilization of dermatologic care is integral to developing policy approaches to increasing access to care across the country.  Continue reading

CDC: Homicide Rates At Least 10 Times Higher For Young Adult Blacks Than Whites

MedicalResearch.com Interview with:

Dr. Kameron Sheats PhD Licensed Psychologist; Behavioral Scientist Centers for Disease Control and Prevention

Dr. Sheats

Dr. Kameron Sheats PhD
Licensed Psychologist; Behavioral Scientist
Centers for Disease Control and Prevention

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

Response: This study updates literature on racial disparities in violence between black and white youth using data capturing different severity levels in violent outcomes such as homicide versus assault. This study also seeks to increase the understanding of the impact of these disparities by examining associations between disparities in childhood adversity (e.g., child abuse and neglect, exposure to violence, household challenges) and adult health conditions.

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Complex Racial and Ethnic Disparities in Childhood Cancer Survival

MedicalResearch.com Interview with:
Rebecca D. Kehm, PhD
Division of Epidemiology and Community Health
University of Minnesota School of Public Health
Minneapolis, MN  

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

Response: Racial and ethnic differences in childhood cancer survival have long been known, and there has been some research indicating that SES could explain disparities. However, our study is the first to use statistical methods that put numbers to the relative contribution of SES to survival disparities for different types of childhood cancer. We set out to investigate whether racial and ethnic disparities in childhood cancer survival are attributed to underlying differences in socioeconomic status, defined as one’s social and economic position in relation to others based on income, education, and occupation, which scientists abbreviate as SES. Our findings provide evidence that SES does in fact contribute to racial and ethnic disparities in survival for some types of childhood cancer. Specifically, we found that SES accounted for 28-73% of the racial and ethnic survival disparity for acute lymphoblastic leukemia, acute myeloid leukemia, neuroblastoma, and non-Hodgkin lymphoma. However, SES did not significantly contribute to racial and ethnic disparities in survival for other types of childhood cancer including central nervous system tumors, soft tissue sarcomas, Hodgkin lymphoma, Wilms tumor, and germ cell tumors. These tumor-specific results help inform where to place resources to best reduce racial and ethnic survival disparities for each of the major types of childhood cancer.

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Who is Underrepresented in Cardiology Trials?

MedicalResearch.com Interview with:

Quoc Dinh Nguyen, MD MA MPH Interniste-gériatre – Service de gériatrie Centre hospitalier de l’Université de Montréal – CHUM

Dr. Nguyen

Quoc Dinh Nguyen, MD MA MPH
Interniste-gériatre – Service de gériatrie
Centre hospitalier de l’Université de Montréal – CHUM

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

Response: Randomized trials are the best evidence basis we have to treat patients. It is known for more than 20 years that older adults and women are disproportionately excluded from randomized trials in cardiology diseases. As the current US population is fast aging, we examined whether this underrepresentation improved or worsened in the last 20 years in the most influential studies published between 1996 and 2015.

The main finding is that the women and older adults continue to be underrepresented in cardiology trials. Overall, the mean age was 63 years and the percentage of women was 29%. For coronary heart disease, women comprise 54% of the US population in need of treatment, yet are only 27% of the trial population. For heart failure, the median age of older adults in the US population is 70 years whereas it is only 64 years in the trial population.

Our results indicate that the gap has very slowly narrowed in the last 2 decades. However, based on current trends, reaching proportionate enrollment would require between 3 and 9 decades. This persistent lack of representation has significant impacts on the ability of clinicians to provide evidenced based care for these segments of the population. Physicians and other health care professionals are forced to extrapolate study results from younger and male-predominant populations. This is problematic since we know that older adults and women may react differently to medications and to interventions.  Continue reading

More Medicaid Enrollees Receiving Treatment for Opioid Use Disorder, But Disparities Remain

MedicalResearch.com Interview with:

Bradley D. Stein MD PhD Senior Physician Policy Researcher Pittsburgh Office Rand Corporation

Dr. Stein

Bradley D. Stein MD PhD
Senior Physician Policy Researcher
Pittsburgh Office
Rand Corporation

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

Response: Increasing use of medication treatment for individuals with opioid use disorders, with medications like methadone and buprenorphine, is a critical piece of the nation’s response to the opioid crisis. Buprenorphine was approved by the FDA in 2002 for treatment of opioid use disorders, but there was little information about to what extent buprenrophine’s approval increased the number of Medicaid-enrollees who received medication treatment in the years following FDA approval nor to what extent receipt of such treatment was equitable across communities.

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Racial Disparities in Prurigo Nodularis (Extremely Itchy Lumps)

MedicalResearch.com Interview with:

Prurigo Nodularis credit: Johns Hopkins Medicine

Prurigo Nodularis
credit: Johns Hopkins Medicine

Dr. Shawn Kwatra MD
Assistant Professor of Dermatology
Johns Hopkins University School of Medicine 

MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by prurigo nodularis? 

Response: Prurigo nodularis is a skin condition where patients develop extremely itchy nodules throughout the body. Little is known about why this happens or which groups of people are predisposed to develop this condition.

MedicalResearch.com: What are the main findings?

Response We found that prurigo nodularis disproportionately affects African-Americans as compared to the general population. Diabetes, Hepatitis C, chronic kidney disease, and HIV are also more common in patients with prurigo nodularis than the general population or patients with other inflammatory skin diseases studied, such as atopic dermatitis and psoriasis.

We also found that people with prurigo nodularis are more likely to be depressed than patients with other inflammatory skin diseases, such as atopic dermatitis or psoriasis. 

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African Americans Less Likely To Be Treated With Statins

MedicalResearch.com Interview with:

Michael G. Nanna, MD Fellow, Division of Cardiology Duke University Medical Center Durham, NC

Dr. Nanna

Michael G. Nanna, MD
Fellow, Division of Cardiology
Duke University Medical Center
Durham, NC

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

Response: We know that African Americans are at higher risk for cardiovascular disease than white patients. We also know that African American individuals have been less likely to receive statin therapy compared to white individuals in the past. However, the reasons underlying these racial differences in statin treatment are poorly understood. We set out to determine if African American individuals in contemporary practice are treated less aggressively than whites and, if so, we wanted to investigate potential reasons why this might be the case.

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How Much US Life is Lost to Police Violence?

MedicalResearch.com Interview with:
“police” by istolethetv is licensed under CC BY 2.0Anthony L. Bui, MPH

M.D. Candidate, David Geffen School of Medicine at UCLA
Matthew M. Coates, MPH
Associate, Harvard Medical School, Department of Global Health and Social Medicine
Ellicott C. Matthay, MPH
Ph.D. Candidate, Division of Epidemiology, University of California, Berkeley School of Public Health

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

Response: Protests after recent deaths from encounters with law enforcement, the Black Lives Matter movement, and activism over social media platforms have raised the profile of the problem of police violence. Several studies have suggested that the public health community has a duty to address these deaths as a public health problem. These studies have also pointed out that although there is a lack of officially reported statistics on police violence, other journalistic and crowd-sourced efforts such as “The Counted” from The Guardian, FatalEncounters.org, U.S. Police Shootings Database, KilledbyPolice.net, and Mapping Police Violence have relatively complete documentation of deaths from police violence.

To help frame the issue as a public health problem, we calculated years of life lost (YLLs) attributed to deaths from encounters with law enforcement. YLLs are, a metric that measures premature deaths, by age, gender, and race/ethnicity. To do this, we followed established methods, subtracting the age of each death from a corresponding standard life expectancy. For example, if an individual who died at age 25 had a life expectancy of 75, their YLL would be 50.  Continue reading

Do Blacks Still Get More Opioid Prescriptions?

MedicalResearch.com Interview with:

Matthew A. Davis, MPH, PhD Assistant Professor Department of Systems, Populations and Leadership University of Michigan

Dr. Davis

Matthew A. Davis, MPH, PhD
Assistant Professor
Department of Systems, Populations and Leadership
University of Michigan

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

Response: The premise for the study was based on prior work that demonstrated that the likelihood of being prescribed an opioid differs according to a patient’s race and ethnicity.  Collectively this work has shown that Non-Hispanic Whites are more likely to receive opioids than other groups for pain.

We decided to look at trends in the prescribing of different pain medications over the last 16 years to see if we could detect any differences in prescribing patterns among racial and ethnic groups.  To do so we used national health data for a large sample of Americans who live with significant pain.

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Racial Disparities in Post-Procedure ED Visits and Hospitalizations

MedicalResearch.com Interview with:

Dr-Hillary-J-Mull

Hillary J. Mull, PhD, MPP
Center for Healthcare Organization and Implementation Research
Veterans Affairs (VA) Boston Healthcare System
Department of Surgery, Boston University School of Medicine
Boston, Massachusetts

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

Response: Little is known about outpatient procedures that can be considered invasive but are not conducted in a surgical operating room. These procedures are largely neglected by quality or patient safety surveillance programs, yet they are increasingly performed as technology improves and the U.S. population gets older.

We assessed the rate of invasive procedures across five specialties, urology, podiatry, cardiology, interventional radiology and gastroenterology in the Veterans Health Administration between fiscal years 2012 and 2015. Our analysis included examining the rates of post procedure emergency department visits and hospitalizations within 14 days and the key patient, procedure or facility characteristics associated with these outcomes. We found varying rates of post procedure ED visits and hospitalizations across the specialties with podiatry accounting for a high volume of invasive outpatient care but the lowest rate of postoperative utilization (1.8%); in contrast, few of the procedures were in interventional radiology, but the postoperative utilization rate was the highest at 4.7%. In a series of logistic regression models predicting post procedure healthcare utilization for each specialty, we observed significantly higher odds of post procedural outcomes for African American patients compared to white patients.

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Dark Skin Tones May Be Underrepresented in Medical Textbooks

MedicalResearch.com Interview with:

Patricia Louie, MA PhD Student, Department of Sociology University of Toronto Toronto, ON, Canada

Patricia Louie

Patricia Louie, MA
PhD Student, Department of Sociology
University of Toronto
Toronto, ON, Canada 

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

 

Response: While most physicians believe that they treat patients equally, research shows that racial inequality pervades the U.S. health care system (Feagin and Bennefield 2014; Williams 2012). Because these inequities persist even after demographic and other socio-economic differences are taken into consideration scholars have started to look at the representation of race in the medical curriculum. The idea is that medical curriculum creates both implicit and explicit connections between race and disease. We build on this body of work by investigating the representation of race (White, Black and Person of Color) and skin tone (light, medium and dark) in the images of four preclinical anatomy textbooks – Atlas of Human AnatomyBates’ Guide to Physical Examination & History Taking, Clinically Oriented Anatomy, and Gray’s Anatomy for Students.  Skin tone is important.

The majority of medical imagery consists of decontextualized images of body parts where skin tone, which may be related to disease presentation, is the only phenotypical marker. If doctors associate light skin tones with White patients, this may also influence how doctors think about who is a “typical” patient, particularly for the type of disease that is shown in that image.

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Increased Diabetes Risk in African Americans Explained by Greater Obesity Rates

MedicalResearch.com Interview with:

Michael P. Bancks, PhD Northwestern University Chicago, Illinois 

Dr. Bancks

Michael P. Bancks, PhD
Northwestern University
Chicago, Illinois 

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

Response: We know that the disparity in diabetes between black and white youth and young adults is growing, but the reasons why are unclear. We also know that traditional risk factors for diabetes, such as obesity and low socioeconomic status, are more common among blacks as compared with whites.

Our study describes how the unequal rates of these traditional diabetes risk factors explain or account for the higher rates of diabetes among blacks.

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Breast Cancer Survival Remains Lower For Black Women

MedicalResearch.com Interview with:
“Family Weekend 2014-Breast Cancer Walk” by Nazareth College is licensed under CC BY 2.0
Dr. Jacqueline Miller, MD
Division of Cancer Prevention and Control
CDC 

MedicalResearch.com: What efforts have proven successful in reducing racial disparities like these?

Response: While some racial disparities will exist due to differences in tumor types, improving early diagnosis and providing specific treatment based on tumor characteristics in a timely fashion would result in reducing breast cancer disparities.

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