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PubMedDate not supplied

The community need index. A new tool pinpoints health care disparities in communities throughout the nation.

Catholic Healthcare West, San Francisco (CHW), has developed a national Community Need Index (CNI) in partnership with Solucient, an information products company, to help health care organizations, not-for-profits, and policymakers identify and address barriers to health care access in their communities. The CNI aggregates five socioeconomic indicators long known to contribute to health disparity--income, culture/language, education, housing status, and insurance coverage--and applies them to every zip code in the United States. Each zip code is then given a score ranging from 1.0 (low need) to 5.0 (high need). Residents of communities with the highest CNI scores were shown to be twice as likely to experience preventable hospitalization for manageable conditions--such as ear infections, pneumonia or congestive heart failure--as communities with the lowest CNI scores. The CNI provides compelling evidence for addressing socioeconomic barriers when considering health policy and local health planning. The tool highlights health care disparities between geographic regions and illustrates the acute needs of several notable geographies, including inner city and rural areas.Further, it should enable health care providers, policymakers, and others to allocate resources where they are most needed, using a standardized, quantitative tool. The CNI provides CHW with an important means to strategically allocate resources where it will be most effective in maintaining a healthy community.

Community Health Planning↗
PubMed2005

Health disparities: a barrier to high-quality care.

PURPOSE: Disparities in the treatment of cardiovascular disease, diabetes mellitus, and cancer among the sexes and racial groups and possible interventions are discussed. SUMMARY: The ongoing process to identify and reduce health disparities has engaged numerous federal agencies as they monitor the nation's progress toward policy-driven and health-related objectives. Cardiovascular disease disproportionately affects minority groups and is the leading cause of death among women in the United States, and both groups receive suboptimal care for the disease. Disparities in the treatment of diabetes mellitus in African Americans, women, patients with less than a high school education, and the elderly have been found. Many minority groups continue to suffer disproportionately from cancer. Racial disparities also exist in cancer screening and treatment. Minorities are underrepresented in clinical trials for multiple reasons, many of which may be related to cultural beliefs. At all levels of coinsurance, the poor are less likely to seek preventive care. Adherence to national screening and treatment guidelines, clinical trial recruitment and participation, addressing language and geographic barriers, and increasing access to insurance are part of the coordinated efforts required to reduce health disparities. Because pharmacists influence patients' health status directly through pharmaceutical care and indirectly by engaging patients in their treatment, it is essential for pharmacists to be able to provide culturally competent care. CONCLUSION: Despite significant efforts over the past several years, health disparities continue to exist, particularly among minority groups. Interventions aimed at eliminating these disparities should include ensuring cultural competence among health care providers and improving health literacy among patients.

Attitude of Health Personnel↗
PubMed2005

Racial and socioeconomic disparities in health from population-based research to practice-based research: the example of oral health.

Oral health serves as an excellent model for understanding social disparities in health. Associations among race, socioeconomic status, oral health, and dental care are strong. Multiple points along the dental care process allow investigation of disparities and mechanisms; and there are multiple types of treatment services (ranging from those that all patients and clinicians would likely agree on, to multiple treatment options, to discretionary treatments). Florida Dental Care Study (FDCS) data are used to provide examples of these concepts. Without regard to whether the dental care system was ultimately entered, the FDCS found substantive social differences in 1) incidence of need; 2) responsiveness to this need; and 3) propensity to seek preventive services. Once the dental care system had been accessed, substantive social differences were still evident with regard to 1) clinical condition; 2) awareness of treatment options; and 3) treatment discussions and recommendations. Once differences in clinical condition were taken into account, and once analysis was limited to persons who had entered the dental care system, social differences in receipt of care were still evident. Findings suggested that although dental care was effective at treating and preventing certain oral conditions, social differences in treatment effectiveness were evident.

Aged↗
PubMed2006

Implementing the Institute of Medicine definition of disparities: an application to mental health care.

OBJECTIVE: In a recent report, the Institute of Medicine (IOM) defines a health service disparity between population groups to be the difference in treatment or access not justified by the differences in health status or preferences of the groups. This paper proposes an implementation of this definition, and applies it to disparities in outpatient mental health care. DATA SOURCES: Health Care for Communities (HCC) reinterviewed 9,585 respondents from the Community Tracking Study in 1997-1998, oversampling individuals with psychological distress, alcohol abuse, drug abuse, or mental health treatment. The HCC is designed to make national estimates of service use. STUDY DESIGN: Expenditures are modeled using generalized linear models with a log link for quantity and a probit model for any utilization. We adjust for group differences in health status by transforming the entire distribution of health status for minority populations to approximate the white distribution. We compare disparities according to the IOM definition to other methods commonly used to assess health services disparities. PRINCIPAL FINDINGS: Our method finds significant service disparities between whites and both blacks and Latinos. Estimated disparities from this method exceed those for competing approaches, because of the inclusion of effects of mediating factors (such as income) in the IOM approach. CONCLUSIONS: A rigorous definition of disparities is needed to monitor progress against disparities and to compare their magnitude across studies. With such a definition, disparities can be estimated by adjusting for group differences in models for expenditures and access to mental health services.

Adolescent↗
PubMed1998

The impact of social class on the use of cancer screening within three racial/ethnic groups in the United States.

Despite the consistent and strong association of social class with health status, the extent to which racial/ethnic disparities in cancer screening reflect social class is rarely addressed. We hypothesized that the use of cancer screening is positively correlated with social class for black, white and Hispanic Americans. Data from the 1987 and 1992 National Health Interview Survey Cancer Control Supplements were compared for each racial/ethnic group by income, education, age, and gender. For each racial/ethnic group, individuals with less education or income are less likely to be screened. Although specific subgroups increased their use of screening modalities between 1987 and 1992, older black Americans who were poor or had less education reported less screening than similar older white Americans. Although social class is a powerful explanatory variable for younger Americans, racial disparities in cancer screening persist among older black Americans.

Black or African American↗
PubMed2001

The convergence of vulnerable characteristics and health insurance in the US.

This study defines vulnerability as a multi-dimensional construct, reflected in the convergence of predisposing, enabling, and need attributes of risk. Using race, income, and self-perceived health status as indicators and based on eight rounds of the US 1996 panel of the Medical Expenditure Panel Survey, the study examined how the interactions of these vulnerable characteristics affect insurance coverage, a critical measure of health care access. The results of the study demonstrate insurance coverage does vary with the extent of vulnerability. While race and income significantly influence insurance coverage, respectively, there was relatively little disparity in insurance due to health status. Between race and income, income was a more significant predictor of lack of insurance coverage since low-income people regardless of race and health were significantly more likely to be uninsured or partially insured. However, it is important to note that minorities were disproportionately over-represented in the low-income or bad health groups so that any adverse association between income, bad health, and insurance status would affect minorities significantly more than whites. Among those with insurance, the most vulnerable group, the minority-low-income-bad health group or those with all the three vulnerability indicators, were most likely to be publicly insured. A policy implication is to target limited resources on insurance coverage for the more vulnerable groups, those with a convergence or cluster of predisposing, enabling, and need attributes of risk.

Health Services Research↗
PubMed2005

ACOG committee opinion. Number 317, October 2005. Racial and ethnic disparities in women's health.

Significant racial and ethnic disparities exist in women's health. These health disparities largely result from differences in socioeconomic status and insurance status. Although many disparities diminish after taking these factors into account, some remain because of health care system-level, patient-level, and provider-level factors. The American College of Obstetricians and Gynecologists strongly supports the elimination of racial and ethnic disparities in the health and health care of women. Health professionals are encouraged to engage in activities to help achieve this goal.

Ethnicity↗
PubMed2005

Radical contextualization: contributions to an anthropology of racial/ethnic health disparities.

There is indisputable evidence of deep and persistent racial/ethnic inequalities in health status and health care in the USA. Growing awareness of these disparities has fueled a cross-disciplinary debate about appropriate approaches to racial/ethnic disparities in public health research and policy discourse, yet anthropologists have been marginalized in this discourse. What does the current work of anthropologists have to offer that is most useful in the crucial work of understanding and eliminating health disparities? We examine anthropological research and practice that constitute core contributions to an anthropology of racial/ethnic health disparities. We identify the following themes: (1) using ethnography as a tool for new inequality knowledge; (2) studying up; and (3) formulating alternative models of biosocial pathogenesis. These elements of anthropological methods, theory and practice can contribute to a better understanding of the social processes that underpin racial/ethnic health disparities and help identify opportunities for interrupting them.

Anthropology↗
PubMed2005

Racial/ethnic variation in functional and self-reported health.

OBJECTIVES: We investigated whether racial/ethnic health disparities exist in Canada and whether socioeconomic or behavioral differences between racial/ ethnic minorities and nonminorities account for such disparities. METHODS: We used data from the National Population Health Survey, conducted by Statistics Canada in 1996 and 1997. We used regression models to examine differences in functional and self-reported health. RESULTS: Our study found no association between socioeconomic or behavioral differences and racial/ethnic health disparities. There was no clear pattern between racial/ethnic minority status and health. CONCLUSIONS: The state can play an important role in health outcomes, and public commitment to accessible health care may explain why socioeconomic status and health behaviors are weak indicators of racial/ethnic health variation in Canada.

Adult↗
PubMed2007

The epidemiology of infant injuries and alarming health disparities.

PURPOSE: Injury epidemiology is the underappreciated foundation of injury prevention and control strategies. Given the substantial disparity of infant injury-related mortality between African Americans (AA) and whites in our region, we sought to better understand the epidemiology of infant injury-related mortality rates. METHODS: Our trauma database was reviewed for all infant injuries over a 10-year period. The mortality rates were analyzed based on race, mechanism, and health insurance type. RESULTS: From 1995 to 2004, 1270 infants were identified. Sixty-nine percent were white, 26% AA, and 5% were other. Overall mortality was 4.8%. There were significant disparities in mortality comparing AA to whites: overall, 9.6% vs 2.8%*; abuse, 15% vs 4%*; suffocation, 100% vs 55%* (*P < .05). Although 75% of AA vs 40% of whites were insured by Medicaid, when separated by insurance type, the disparity in mortality rates between races remained significant. CONCLUSIONS: African-American infants have 3.5 times increased risk of death from preventable injuries compared to white infants. This disparity persists despite controlling for type of health insurance, a surrogate for socioeconomic status. Understanding these disparities and developing injury-prevention programs targeting high-risk mechanisms of injury such as abuse and suffocation among AA is critical toward eventually eliminating these preventable deaths.

Black or African American↗
PubMed2006

A conceptual model of work and health disparities in the United States.

Recent research in medicine and public health highlights differences in health related to race, ethnicity, socioeconomic status, and gender. These inequalities, often labeled "disparities," are pervasive and pertain to the major causes of morbidity, mortality, and lost life years. Often ignored in discussions of health disparities is the complex role of work, including not only occupational exposures and working conditions, but also benefits associated with work, effects of work on families and communities, and policies that determine where and how people work. The authors argue that work should be considered explicitly as a determinant of health disparities. Their conceptual model and empirical evidence, built on previous contributions, describe how work contributes to disparities in health on multiple levels. The examples focus on the United States, but many of the key conceptual features can also be applied to other countries. The model emphasizes behaviors and characteristics of institutions rather than individual workers. This approach avoids a focus on individual responsibility alone, which may lead to victim blaming and failure to emphasize policies and institutional factors that affect large populations and systematically create and maintain racial, gender, and socioeconomic disparities in health.

Causality↗
PubMedDate not supplied

Resource planning for patient-centered, collaborative care.

In this article, we use self-reported information from 13,271 older adults and the results from several controlled trials to construct a planned-care management strategy that cuts across diseases and conditions and also addresses health disparities attributed to low socioeconomic status. Three strata result from the interaction of patients' financial status, the presence or absence of bothersome pain and psychosocial problems, and their confidence with self-care. A majority of ambulatory patients generally fall in the first stratum. More resources are required in the 2 remaining strata to attain patient-centered, collaborative care. Because the planned-care management strategy is behaviorally sophisticated, it is likely to be more efficient and effective than strategies based on concepts of disease management that focus on either a single disease or groupings of patients who are "high utilizers" of healthcare. We conclude that modern technologies and related approaches make resource planning for patient-centered, collaborative care feasible and desirable.

Aged↗
PubMed2004

Changes in health insurance coverage and health status by race and ethnicity, 1997-2002.

Recent years have seen shifts in health insurance coverage associated with economic fluctuations and changes in health policy. The analysis presented here uses data from the National Survey of America's Families to examine changes in health insurance coverage and respondent-reported health status by race and ethnicity. The data indicate that public coverage increased for black, Hispanic and white children between 1997 and 2002. Uninsurance rates fell among children in low-income black, Hispanic and white families, remained constant among black and white children in higher-income families, and increased among higher-income Hispanic children. The health status of children was stable for blacks, Hispanics and whites except for a decline in health among higher-income Hispanic children. Black and white adults saw increases in public health insurance coverage but not in overall coverage. The uninsurance rate of Hispanic adults increased, despite expanded public coverage of higher-income Hispanic adults. None of these developments altered racial and ethnic disparities in health. Hispanics fared worse than blacks in both health status and insurance coverage, and blacks fared worse than whites. Given the anticipated growth of minority populations in the United States, the nation's health will deteriorate if policymakers allow current disparities to continue.

Adolescent↗
PubMed2006

Fatigue varies by social class in African Americans but not Caucasian Americans.

Socioeconomic status explains many ethnic disparities in health; however, mechanisms are hard to identify. Fatigue-a frequent complaint in patients and normals-is associated with poorer quality of life. We wondered if ethnicity and social class interact to explain fatigue. A total of 40 African Americans (AAs) and 64 Caucasian Americans (CAs) completed short forms of the Profile of Mood States (POMS-SF) and Multidimensional Fatigue Symptom Inventory (MFSI-SF). Participants were divided into high-middle and low social class groups (as per Hollingshead, 1958a). After controlling for gender, body mass index, depressive symptoms, and response bias, ethnicity and social class interacted for POMS-SF fatigue. AAs in the high-middle classes reported more fatigue than AAs in the low classes and CAs in the high-middle classes. Fatigue did not differ by class for CAs nor by ethnicity in the lower classes. Similar findings emerged for MFSI-SF general fatigue. Social class is important for understanding fatigue in AAs but not CAs.

Adult↗
PubMed2006

Environmental barriers to health care among persons with disabilities--Los Angeles County, California, 2002-2003.

In 2002, an estimated 51.2 million persons in the United States (approximately 18.1% of the population) had a disability. Recent data suggest that substantial disparities in health behaviors and overall health status exist between persons with and without disabilities. Nonetheless, when they have access to adequate health care, persons with disabilities can lead healthy lives. The World Health Organization's International Classification of Functioning, Disability, and Health stresses the importance of environment (e.g., physical environment, attitudes of others, or policies) as either a barrier or facilitator in the daily activities of persons with disabilities. In addition, increasing access to health and wellness treatment programs for persons with disabilities and reducing the proportion of persons with disabilities who report environmental barriers to participation in daily activities are goals of Healthy People 2010 (objectives 6-10 and 6-12). However, few population-based studies have explored how environment affects the lives of those with disabilities. To determine the prevalence of disability among persons in Los Angeles County, California, and assess the effects of environmental barriers on these persons, residents were surveyed during 2002-2003. The results of that survey suggested that persons with physical or sensory disabilities experienced several environmental barriers and that the prevalence of barriers varied by demographic characteristics, household income, and severity of disability. To improve quality of life among persons with disabilities, public and private health agencies should implement measures to remove environmental barriers to health care and other services.

Adolescent↗
PubMed1999

Disparities of health in African Americans.

As a cohort of the vulnerable populations, African Americans have the poorest health status indicators of all ethnic groups. Using a vulnerable populations theoretical framework, the reasons for the disparities are discussed.

Adult↗
PubMed2006

Indigenous health and socioeconomic status in India.

BACKGROUND: Systematic evidence on the patterns of health deprivation among indigenous peoples remains scant in developing countries. We investigate the inequalities in mortality and substance use between indigenous and non-indigenous, and within indigenous, groups in India, with an aim to establishing the relative contribution of socioeconomic status in generating health inequalities. METHODS AND FINDINGS: Cross-sectional population-based data were obtained from the 1998-1999 Indian National Family Health Survey. Mortality, smoking, chewing tobacco use, and alcohol use were four separate binary outcomes in our analysis. Indigenous status in the context of India was operationalized through the Indian government category of scheduled tribes, or Adivasis, which refers to people living in tribal communities characterized by distinctive social, cultural, historical, and geographical circumstances.Indigenous groups experience excess mortality compared to non-indigenous groups, even after adjusting for economic standard of living (odds ratio 1.22; 95% confidence interval 1.13-1.30). They are also more likely to smoke and (especially) drink alcohol, but the prevalence of chewing tobacco is not substantially different between indigenous and non-indigenous groups. There are substantial health variations within indigenous groups, such that indigenous peoples in the bottom quintile of the indigenous-peoples-specific standard of living index have an odds ratio for mortality of 1.61 (95% confidence interval 1.33-1.95) compared to indigenous peoples in the top fifth of the wealth distribution. Smoking, drinking alcohol, and chewing tobacco also show graded associations with socioeconomic status within indigenous groups. CONCLUSIONS: Socioeconomic status differentials substantially account for the health inequalities between indigenous and non-indigenous groups in India. However, a strong socioeconomic gradient in health is also evident within indigenous populations, reiterating the overall importance of socioeconomic status for reducing population-level health disparities, regardless of indigeneity.

Alcohol Drinking↗