KAISER HEALTH DISPARITIES REPORT: A WEEKLY LOOK AT RACE, ETHNICITY AND HEALTH

POLITICS & POLICY

1. House Hearing Examines Immigrant Care at Detention Facilities
[Mar-06-2009]

YOUTH & HEALTH

2. Congressional Hearing Explores High Suicide Rates Among American Indian Youth
[Mar-02-2009]

3. Asian, Pacific Islanders Have High Rates of Type 1 and Type 2 Diabetes, Study Finds
[Mar-03-2009]

4. Fewer Young Children Have Elevated Lead Levels, Study Finds
[Mar-03-2009]

5. Redefining Vitamin D Deficiency Would Mean Many More Black Teens Would Have Unhealthy Levels, Study Finds
[Mar-06-2009]

SCIENCE & MEDICINE

6. Heart Attack Outcomes Worse for Blacks Than Whites Due in Part to Individual Characteristics, Study Finds
[Mar-04-2009]

COVERAGE, ACCESS AND QUALITY

7. Contra Costa County Considering Health Services Cuts for Undocumented Immigrants, Inmates
[Mar-04-2009]

8. Black Heart Attack Patients Living in Certain Areas Are More Likely Than Whites To Be Admitted to Hospitals With Higher Mortality Rates
[Mar-04-2009]

9. Seattle Report Ranks Local Hospitals on Access to Care for Minorities, Low-Income Individuals
[Mar-05-2009]

10. Providence Journal Examines Pre-Term Birth Rate Among Black Women
[Mar-02-2009]

CULTURE-BASED CARE

11. Wilmington News Journal Examines Bilingual Hospital Staff Serving as Interpreters
[Mar-05-2009]

PUBLIC HEALTH

12. Blacks in Tennessee County Disproportionately Affected by Tuberculosis; Effort Seeks To Raise Awareness Among High-Risk Groups
[Mar-06-2009]

INITIATIVES

13. Efforts, Events Seek To Address Health Disparities Among Minorities
[Mar-06-2009]

RECENT RELEASES IN HEALTH DISPARITIES

14. Issue Briefs Examine Racial, Ethnic Health Disparities Among Children
[Mar-03-2009]

POLITICS & POLICY

Efforts to improve medical care for immigrants detained by Immigration and Customs Enforcement must improve, witnesses and lawmakers said on Tuesday during a House Appropriations Homeland Security Subcommittee hearing, CQ HealthBeat reports. Last year, a Washington Post series examined the lack of medical care for some immigrants detained at ICE facilities. Alicia Puente Cackley, director of health care for the Government Accountability Office, said that a report recently released by the office found variations in medical care provided at ICE facilities and the lack of a standardized system for maintenance of health records at the facilities.

According to Jose Rodriguez, director of the ICE Division of Immigration Health Services, national detention standards require immigrants within 12 hours of detention to receive a medical assessment that includes a health questionnaire, a dental evaluation, a tuberculosis skin test and a pregnancy test for women ages 10 to 55. Rodriguez added that immigrants detained for at least two weeks must receive a more comprehensive medical assessment that includes a detailed history and a complete physical examination.

He also said that DIHS has begun to evaluate several electronic health record systems. James Hayes, director of the ICE Office of Detention and Removal Operations, acknowledged the need for improvement and indicated support for unannounced evaluations of ICE facilities. However, he added that the mortality rate for immigrants detained at ICE facilities decreased from 10.8 deaths per 100,000 detainees in 2004 to 2.7 deaths per 100,000 detainees in 2008. Hayes said, "Given the generally poor health of detainees who enter ICE custody, the comparatively low death rate among ICE detainees provides evidence of the extraordinary measures ICE takes to prevent the death of any ICE detainee in our care" (Attias, CQ HealthBeat, 3/4).

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YOUTH & HEALTH

Eight policymakers, tribal members and health care experts discussed the high rate of suicide among American Indian youth on Thursday during a Senate Committee on Indian Affairs hearing, CQ HealthBeat reports. According to Robert McSwain, director of the Indian Health Service, suicide is the second leading cause of death among American Indians ages 15 to 24 who live in IHS service areas. Suicide among American Indians and Alaska natives is 70% higher than that of the general U.S. population, according to Committee Chair Byron Dorgan (D-N.D.) (Attias, CQ HealthBeat, 2/27).

Sen. Tom Udall's (D-N.M.) office said that research has shown factors such as drug and alcohol use, unemployment, isolation, domestic violence, barriers to effective mental health care and gang activity are suicide risk factors. Complicating suicide prevention among American Indian youth is the ability to address cultural sensitivities, as well as that IHS is underfunded, Marissa Padilla, a spokesperson for Udall, said.

Padilla added, "With increased funding comes increased services. IHS being 40% underfunded is a travesty. We have to beef up what IHS receives in order to improve the systems that exist within it."

In a statement, Udall said, "The suicide rates among our Native youth are devastating, and we must continue to do everything possible to help prevent this vicious cycle. Tribal members must have access to support systems that are culturally sensitive and flexible to their needs" (Montelone, Farmington Daily Times, 2/28).

Robert Moore, a member of the Great Plains Tribal Chairmen's Association and the Aberdeen Area Tribal Chairman's Health Board, called for improved communication, cooperation, and data sharing between tribes and IHS (CQ HealthBeat, 2/27).

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Asian and Pacific Islander children living in the U.S. have higher rates of type 1 and type 2 diabetes than children living in Asian countries, according to a 10-year study of the disease in children, the Honolulu Advertiser reports. The SEARCH for Diabetes in Youth multicenter study is the largest ever surveillance of youth with diabetes, according to the Advertiser. Beatriz Rodriguez, a professor at the University of Hawaii's John A. Burns School of Medicine, is lead investigator of the Hawaii site SEARCH study. More than half of the Asian and Pacific Islander children included in the nationwide study are from Hawaii, according to Rodriguez.

Rodriguez found that rates of type 1 diabetes among Asian and Pacific Islanders ages 13 and younger who live in the U.S. are at least three times higher than the rates among children living in Japan, Korea, Shanghai, Taiwan, Thailand and Singapore.

Type 2 diabetes also was significantly higher in the U.S. group, according to the study. For example, 12.1 children per 100,000 in the U.S. had the disease, compared with 2.6 children per 100,000 in Japan and 6.5 per 100,000 in Taiwan. Approximately one in 8,200 Asian and Pacific Islander U.S. youth between ages 10 and 19 is diagnosed with type 2 diabetes annually, according to the study.

Rodriguez said that researchers were expecting the higher rates of type 2 diabetes among Asian and Pacific Islander children living in the U.S. because the disease is closely linked with obesity, physical inactivity and race, but the higher type 1 finding was a surprise. Causes of type 1 diabetes, an autoimmune disorder, are less clear, but Rodriguez said a number of genetic and nongenetic factors, such as infections at birth, toxins and early cessation of breastfeeding, are likely contributors.

The findings suggest that public health efforts targeting Asian and Pacific Islander children and other minorities, should stress the importance of obesity and prevention of diabetes, according to Rodriguez (Wilson, Honolulu Advertiser, 2/28).

An abstract of the study is available online. Reports on findings for other racial and ethnic groups also are available in the March issue of Diabetes Care online.

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The number of young U.S. children who had elevated levels of lead in their blood decreased by 84% between 1988 and 2004, according to a study published on Monday in the journal Pediatrics, the AP/Philadelphia Inquirer reports. For the study, CDC researchers examined data on almost 5,000 children ages one to five who participated in a periodic government health survey. Researchers considered children who had at least 10 micrograms of lead per deciliter of blood to have elevated levels.

The study found that the percentage of young children who had elevated levels of lead in their blood decreased from 9% in 1998 to 1.4% in 2004. According to the study, young children from lower-income families had higher levels of lead in their blood than children from higher income families. The study found almost no racial disparities among young children who had at least 10 micrograms of lead per deciliter of blood in 2004. However, 18% of young white children had less than one microgram of lead per deciliter of blood, compared with 11% of Mexican-American children and 4% of black children, according to the study. Researchers said that the decrease in children who had elevated levels of lead in their blood resulted from efforts to reduce their exposure to lead in old house paint, soil water and other sources.

Study co-author Mary Jean Brown said, "It has been a remarkable decline," adding, "It's a public health success story." Caroline Cox, research director of the Center for Environmental Health, said, "There's no reason even one child in the United States should be poisoned by lead," adding, "It's great there aren't as many now as there were, but there are still too many" (Tanner, AP/Philadelphia Inquirer, 3/2).

The study is available online.

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Changing the definition of vitamin D deficiency would put many U.S. teenagers, blacks in particular, at unhealthy levels, according to a study published in the March issue of Pediatrics, Reuters Health reports. Having healthy levels of vitamin D is necessary for bone development and maintenance, and it also plays a role in nerve, muscle and immune system function.

According to Reuters Health, "there is debate over how the optimal vitamin D level should be defined." Currently, levels of vitamin D in the blood have to be below 11 nanograms per milliliter to be considered deficient. Some experts consider a level of 30 ng/mL or higher to be desirable for overall health, but many argue that the threshold should be lower at 20 ng/mL.

For the study, Sandy Saintonge of Weill Cornell Medical College and colleagues examined data from a government health survey of about 3,000 teens ages 12 to 19. They found that under the lower optimal level, 14% of the teens would be considered vitamin D deficient, compared with 2% under the current standard. Fifty percent of black teenagers would be deficient, compared with 11% under the current standard, according to the report. Overweight teenagers also had an elevated risk at the lower level, according to Saintonge.

The findings suggest that teens should take vitamin D supplements and have their blood levels routinely checked, especially if they have an increased risk of deficiency, according to the study (Reuters Health, 3/5).

An abstract of the study is available online.

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SCIENCE & MEDICINE

Black heart attack patients have worse outcomes than their white counterparts in large part because of preexisting chronic health conditions and socioeconomic factors, according to a study published in the March issue of Annals of Internal Medicine, Reuters Health reports. For the study, author John Spertus of the Mid America Heart Institute and colleagues analyzed data from a registry of 1,849 heart attack survivors, 28% of whom were black.

According to researchers, 19.9% of black patients died within two years of a heart attack, compared with 9.3% for whites. Blacks also had higher rates of severe chest pain at 28%, compared with 17.8% among whites, and had lower quality of life scores. Blacks also were less likely than whites to undergo a procedure to unblock clogged coronary arteries.

There were no differences in genetics or treatment, and most of the disparities can be attributed to "patient characteristics present before admission," according to the study. Black patients had significantly higher rates of diabetes, high blood pressure, and chronic heart and kidney failure. They also had lower health insurance coverage rates, lower incomes and were less likely to be married. According to researchers, there was some indication that hospital quality partly contributed to the disparities, but "no single omission in the care offered [to] black patients would, if overcome, eradicate the crude differences in observed outcomes" (Reuters Health, 3/2).

An abstract of the study is available online.

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COVERAGE, ACCESS AND QUALITY

This month, the Contra Costa County, Calif., Board of Supervisors will consider a plan to prohibit undocumented adult immigrants from receiving nonurgent, county-funded care, the Contra Costa Times reports. About 5,500 undocumented immigrants are eligible for the county's Basic Health Care Program, which serves low-income residents who cannot obtain any other health insurance.

The county would continue to provide care for undocumented children younger than age 19, as well as provide coverage for emergencies, pregnancies and certain other conditions, including tuberculosis and breast cancer. If approved, the plan to exclude adult undocumented immigrants from primary care services could save the county medical system $6 million annually. Last month, Sacramento County supervisors approved a plan to cut nonurgent care for undocumented immigrants in an effort to save the county $2.4 million.

Contra Costa County also is considering cutting a $2.6 million program that provides health care for inmates of the West County Detention Facility in Richmond.

Tanir Ami, executive director of the Community Clinic Consortium for Contra Costa and Solano counties, said her organization and others are asking supervisors to reconsider the cuts. She said that those who are excluded from county care will be discouraged from seeking primary care altogether, which could endanger the overall health of the community and place a burden on future emergency services (O'Brien, Contra Costa Times, 3/2).

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Black heart attack patients living in racially segregated areas are 35% more likely than whites to be admitted to hospitals with higher mortality rates, even when hospitals that have better outcomes are geographically closer, according to a Health Affairs study released on Tuesday, CQ HealthBeat reports. For the study, Mary Vaughan Sarrazin, an assistant professor at the University of Iowa, and colleagues analyzed hospital admissions of Medicare beneficiaries for heart attacks in 118 health care markets between 2000 and 2005.

Researchers examined straight-line distances between the location of the patient and the hospital where they were admitted, finding that in areas with high levels of hospital segregation, 27% of black patients who lived closer to a hospital not classified as high mortality were admitted to a high-mortality hospital farther away, compared with 9% of white patients under the same circumstance.

Researchers could not determine a single factor behind the disparity but suggested that patient preference and physician referrals might be contributing factors. They also noted that blacks might feel more comfortable being seen by black physicians, who are more likely to be in hospitals with a majority of black patients.

According to CQ HealthBeat, the study has some limitations. It only looked at fee-for-service Medicare beneficiaries; distances between locations, rather than travel time; and areas primarily in the southern U.S. The researchers acknowledged some complexities in measuring racial segregation, as well as the study limitations, but said the findings are an "important step" toward understanding the causes of racial health care disparities.

Sarrazin said, "I think health services researchers are just beginning to understand the influence of culture and diversity on health services." She added, "This study really opens up some conversation about other factors that we had previously not measured" (Skotzko, CQ HealthBeat, 3/2).

The study is available online.

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Four advocacy groups in Seattle on Tuesday issued a report that highlighted disparities in access to care for minorities at several local hospitals, the Seattle Times reports. The report ranked the hospitals based on their access to health care services to minorities and low-income individuals.

The groups -- Northwest Federation of Community Organizations, Washington Community Action Network, Minority Executive Directors Coalition and One America -- called for local hospitals to evaluate whether their practices are contributing to health care disparities among minority communities.

As part of the report, volunteers from the groups posed as Spanish-speaking patients and made about 60 telephone calls or visits to six Seattle-area hospitals, requesting financial assistance information. Eight out of 10 of the inquiries resulted in repeat transfers to other departments or employees hanging up the phone without offering assistance or giving unsatisfactory answers, according to the groups.

The groups also found disparities in how much charity care hospitals provided to low-income patients and proximity to the nearest hospital. The groups maintain that such disparities could exacerbate minority health care disparities and partly explain why minorities' health lags behind that of whites, according to the Times.

"There are geographic, linguistic and financial barriers to accessing medical care. And they disproportionately affect people of color," Gerald Smith, associate director of Northwest Federation of Community Organizations, said.

Virginia Mason Medical Center, one of the hospitals mentioned in the report, rebutted the findings, maintaining that the research does not provide an accurate picture of contributions to the community and to Medicare beneficiaries (Song, Seattle Times, 3/4).

The report is available online (.pdf).

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The Providence Journal on Sunday examined possible reasons for a high pre-term birth rate among black women.

According to the Journal, socioeconomic factors were thought to be the main cause of higher pre-term birth rates among black women, many of whom have low incomes, little education and fewer sources of support. However, research has shown that black women with higher socioeconomic status also have high pre-term birth rates. Other research has investigated the link between genes and high pre-term birth rates. Recently, researchers have looked into whether "day-to-day encounters with discrimination" play a role in the high pre-term birth rates.

In addition, an ongoing study found that infant mortality dropped 70% over five years among blacks in Dane County, Wis., because there were fewer extremely premature infants and premature infants were recovering better than in the past.

In focus groups, researchers found that the "weight of discrimination and racism seemed to be fairly heavy in the older group of women," while younger women "seem to feel very positive about how they're accepted into the community," Thomas Schlenker, public health director of Dane County, said.

Schlenker added, "What I hope (the research) shows it that living in an inclusive and supportive community is good for you. And if we can demonstrate how that actually makes a difference in how babies survive or not ... we will really have something to share with other cities in Wisconsin and elsewhere" (Freyer [1], Providence Journal, 3/1).

The Journal on Sunday also profiled Yvonne Freeman who experienced pre-term birth first-hand and later became an obstetric nurse. Freeman is studying how social conditions can affect pregnancy and also teaches teenage girls about sex, sexually transmitted infections and birth control (Freyer [2], Providence Journal, 3/1).

In addition, the Journal featured a group prenatal care program, Centering Pregnancy (Freyer [3], Providence Journal, 3/1).

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CULTURE-BASED CARE

With a growing population of non-English-speaking patients, many hospitals are training their bilingual staff members to be "effective communicators on health issues," the Wilmington News Journal reports. Many of those providing interpretation services do not have a medical background and might work in the billing, scheduling or custodial departments. A study in the Journal of General Internal Medicine found that one in five hospital workers who sometimes also serve as interpreters have insufficient skills.

Alice Chen, medical director of the General Medicine Clinic at San Francisco General Hospital, said, "Just because you're fluent in another language doesn't mean you'll be able to interpret." She added that because "not every hospital has the resources to hire 20 full-time interpreters," hospital officials need to ensure that their bilingual staff has adequate training. "You don't want to throw someone who is unprepared into an emotional discussion," Chen said.

Another issue is that some English medical terms have no equivalent in other languages. Some hospitals in Delaware have used a seven-week course called Language Liaisons to train staff in "medical Spanish." Another Delaware project, "Spanish Bilingual Assistant Course," focuses on protocol, medical terms and multicultural understanding.

In addition, Phoenix Children's Hospital's Medical Interpreter Project for Children's Hospitals since 2005 has trained interpreters working at children's hospitals across the country. The Ronald McDonald House Charities finances the project (Ratnayake, Wilmington News Journal, 3/3).

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PUBLIC HEALTH

In Davidson County, Tenn., tuberculosis has declined steadily in the past 10 years, but the number of cases among blacks in the county remains disproportionately high, the Tennessean reports. Blacks represent 19% of the county's population, according to state Department of Health epidemiologists; however, in 2008, 35%, or 26, of the 74 TB cases in the county were in U.S.-born blacks.

Alisa Haushalter, director of the Nashville Metro Public Health Department's Bureau of Population Health, said the numbers indicate that blacks in the county are five times more likely to have TB than whites.

A new task force is boosting efforts to educate high-risk groups about the disease. Individuals who live in dorms, jails, homeless shelters and places where drug users congregate have the greatest risk for contracting the disease, according to the Tennessean. "TB is preventable, treatable and curable. I think that's the message we want to get out there," Haushalter said.

Cherry Houston, former director of the Tennessee Department of Health's Division of Minority Health and Health Disparities Elimination, said in a statement, "Unless we also focus on creating partnerships that address poverty, joblessness, homelessness, poor education and all the factors that make people more susceptible to this disease, we will continue on this road of ill health" (Ross, Tennessean, 3/2).

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INITIATIVES

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

• American Cancer Society: ACS within the next week will announce a new breast cancer awareness effort that targets American Indian women, the Sioux Falls Argus Leader reports. American Indian women are less likely to be diagnosed with the disease but tend to have more fatal cases, according to the Argus Leader. The effort will include public service announcements and an 11-minute film produced entirely by American Indians. Roberta Cahill of the Pierre, S.D., division of ACS, said American Indians will connect better with the educational message because it includes members from their own community (Young, Sioux Falls Argus Leader, 3/3).
• Indian Health Services: IHS has extended by two years the multimillion dollar Special Diabetes Program for Indians demonstration projects, which seek to prevent the disease and reduce cardiovascular disease risk among American Indians with diabetes, Indian Country Today reports. The programs funded through SDPI use clinical, team-based case management to treat risk factors for cardiovascular disease, according to Yvette Roubideaux, co-director of the Coordinating Center for the SDPI demonstration projects. IHS' Division of Diabetes Treatment and Prevention will share the outcomes of the demonstration projects in the final year with other American Indian health programs to help tribes start other prevention efforts (Austin, Indian Country Today, 2/27).
• Tacoma, Wash.: The Pierce County AIDS Foundation this week is sponsoring two events to mark National Women and Girls HIV/AIDS Awareness Day on March 10 -- the Black Church Week of Prayer for the Healing of AIDS and a daylong community health fair, which both target the black community, Tacoma Weekly reports. Numerous churches will participate in the week of prayer that ends on Saturday and the community health fair, also on Saturday, will offer no-cost health screenings, counseling, public speakers and entertainment (Nagle, Tacoma Weekly, 3/5).

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RECENT RELEASES IN HEALTH DISPARITIES

The Joint Center for Political and Economic Studies released two issue briefs that are a part of a series related to health disparities among minority children. The issue briefs examine how child health indicators vary by sociodemographic characteristics. Comparisons are made for several health indicators, including low birthweight; health status; unmet dental care needs; lifetime asthma diagnosis; and diagnosis of attention deficit hyperactivity disorder, learning disabilities and activity limitation. The first report includes findings among black and white children, and the second has findings for Hispanic and white children (Joint Center for Political and Economic Studies, January 2009).

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Kaiser Health Disparities Report: A Weekly Look At Race, Ethnicity And Health
The Kaiser Health Disparities Report is published for kaisernetwork.org, a website of the Kaiser Family Foundation. (c) 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

kaisernetwork.org is a free service of the Kaiser Family Foundation. For access to the Kaiser Family Foundation's policy research, analyses, reports and fact sheets, and media partnerships, visit the Foundation's main website at http://www.kff.org.