Minority Health and Health Equity Archive
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Item Racial and Ethnic Disparities in Outcomes and Appropriateness of Carotid Endarterectomy: Impact of Patient and Provider Factors(2009) Halm, E. A.; Tuhrim, S.; Wang, J. J.; Rojas, M.; Rockman, C.; Riles, T. S.; Chassin, M. R.Abstract available at publisher's website.Item Racial/Ethnic Disparities in Exercise and Dietary Behaviors of Middle-Aged and Older Adults(2011) August, Kristin J.; Sorkin, Dara H.Abstract available at publisher's web site.Item Racial and Ethnic Disparities in Indicators of Physical Health Status: Do They Still Exist Throughout Late Life?(2010) August, Kristin J.; Sorkin, Dara H.Abstract available at publisher's web site.Item Disparity Implications of Medicare Eligibility Criteria for Medication Therapy Management Services(2010) Wang, Junling; Mullins, C. Daniel; Brown, Lawrence M.; Shih, Ya-Chen Tina; Dagogo-Jack, Samuel; Hong, Song Hee; Cushman, William C.OBJECTIVE: To determine whether there would be racial and ethnic disparities in meeting eligibility criteria for medication therapy management (MTM) services implemented in 2006 for Medicare beneficiaries. DATA SOURCES/STUDY SETTING: Secondary data analyses of the Medical Expenditure Panel Survey (2004-2005). STUDY DESIGN: Logistic regression and recycled predictions were used to test the disparities in meeting eligibility criteria across racial and ethnic groups. The eligibility thresholds used by health plans in 2006 and new thresholds recommended for 2010 were examined. Racial and ethnic disparities were examined by comparing non-Hispanic blacks (blacks) with non-Hispanic whites (whites) and comparing Hispanics with whites, respectively. Disparities were also examined among individuals with severe health problems. PRINCIPAL FINDINGS: According to 2006 thresholds, the adjusted odds ratios for meeting eligibility criteria for blacks and Hispanics to whites were 0.36-0.60 (p<.05) and 0.13-0.46 (p<.05), respectively. Blacks and Hispanics would be 21-34 and 32-38 percent, respectively, less likely to be eligible than whites according to recycled predictions. Similar patterns were found using the 2010 eligibility thresholds and among individuals with severe health problems. CONCLUSIONS: There would be racial and ethnic disparities in meeting MTM eligibility criteria. Future research is warranted to confirm the findings using data after MTM implementation.Item Key Health Disparities-Focused Legislation Introduced in the 110th Congress(The Henry J. Kaiser Family Foundation, 2007) Thomas, Megan; James, Cara; Lillie-Blanton, MarshaAlthough the 110th Congress is only about half-way through, the number of bills introduced that include some attention to “health disparities” is about the same as introduced in the entire 109th Congress. This compendium summarizes federal legislative efforts introduced in the 110th Congress that focus on addressing racial and ethnic disparities in health and health care. A search of the Library of Congress’ legislative database identified 177 bills introduced thus far in the 110th Congress that met our search criteria. While a number of bills introduced this year may have an impact on health disparities and/or affect minority health, the goal of this document is to highlight legislation that specifically addresses racial and ethnic health disparities. About a dozen such bills have been introduced in the 110th Congress, including the Minority Health Improvement and Health Disparity Elimination Act and the Office of Men’s Health Act of 2007. Many others, such as the Lupus Research, Education, Awareness, Communication, and Healthcare Amendments of 2007 include provisions to address minority populations, but do not specifically focus on disparities. For this reason, this compendium does not discuss them. Several bills introduced in the 110th Congress focus on expanding health insurance coverage to the uninsured, across racial and ethnic groups. Though not included in this compendium, legislation that would improve access to health coverage for minority groups, such as the Children’s Health Insurance Program Reauthorization Act of 2007, the Children’s Dental Health Improvement Act, and the United States National Insurance Act, are of critical importance as more than half of the 47 million uninsured Americans are people of color.Item Compendium of Cultural Competence Initiatives in Health Care(The Henry J. Kaiser Family Foundation, 2003) UNSPECIFIEDactivities that seek to reduce cultural and communication barriers to health care. These activities are often described as cultural competency and/or cross-cultural education. The Institute of Medicine report (2002)1, Unequal Treatment, recommended that the health care system pursue several of these techniques as part of a multi-level strategy to reduce racial and ethnic disparities in medical care. This compendium is a first attempt at describing these activities in a single document. It was prepared in response to the many requests from the media and others to define cultural competency and identify efforts underway in this emerging field. In a recent article, Brach and Fraser (2000)2 clustered the techniques frequently discussed in the literature on cultural competency into nine categories: 1) interpreter services; 2) recruitment and retention policies for minority staff; 3) training; 4) coordinating with traditional healers; 5) use of community health workers; 6) culturally competent health promotion; 7) including family and/or community members in care-giving; 8) immersion into another culture; and 9) administrative or organizational accommodations.Item Racial and Ethnic Disparities in Emergency Department Analgesic Prescription(2003) Tamayo-Sarver, Joshua H.; Hinze, Susan W.; Cydulka, Rita K.; Baker, David W.Objectives. We examined racial and ethnic disparities in analgesic prescription among a national sample of emergency department patients. Methods. We analyzed Black, Latino, and White patients in the 1997–1999 National Hospital Ambulatory Medical Care Surveys to compare prescription of any analgesics and opioid analgesics by race/ethnicity. Results. For any analgesic, no association was found between race and prescription; opioids, however, were less likely to be prescribed to Blacks than to Whites with migraines and back pain, though race was not significant for patients with long bone fracture. Differences in opioid use between Latinos and Whites with the same conditions were less and nonsignificant. Conclusions. Physicians were less likely to prescribe opioids to Blacks; this disparity appears greatest for conditions with fewer objective findings (e.g., migraine).Item Eliminating Racial/Ethnic Disparities In Health Care: Can Health Plans Generate Reports?(2002) Nerenz, David R; Bonham, Vence L; Green-Weir, Robbya; Joseph, Christine; Gunter, MargaretA large and growing literature documents disparities in health status, access to care, and quality of care among racial/ethnic groups in the United States.1 Some analyses find that lack of insurance coverage is an important barrier to getting good care.2 If this were the only significant factor, disparities could be reduced or eliminated by policy initiatives that expanded insurance coverage. There is ample evidence, though, of disparities in quality of care among persons who are insured and among persons with the same type of insurance or in the same health plan.3 Interventions aimed at improving quality of care for members of racial/ethnic minority groups are necessary to reduce these disparities.Item Culturally Competent Healthcare Systems: A Systematic Review(2003) Anderson, Laurie M; Scrimshaw, Susan G; Fullilove, Mindy T; Fielding, Jonathan E; Normand, Jacques; the Task Force on, Community Preventive ServicesCulturally competent healthcare systems—those that provide culturally and linguistically appropriate services—have the potential to reduce racial and ethnic health disparities. When clients do not understand what their healthcare providers are telling them, and providers either do not speak the client’s language or are insensitive to cultural differences, the quality of health care can be compromised. We reviewed five interventions to improve cultural competence in healthcare systems—programs to recruit and retain staff members who reflect the cultural diversity of the community served, use of interpreter services or bilingual providers for clients with limited English proficiency, cultural competency training for healthcare providers, use of linguistically and culturally appropriate health education materials, and culturally specific healthcare settings. We could not determine the effectiveness of any of these interventions, because there were either too few comparative studies, or studies did not examine the outcome measures evaluated in this review: client satisfaction with care, improvements in health status, and inappropriate racial or ethnic differences in use of health services or in received and recommended treatment.Item A STATE POLICY AGENDA TO ELIMINATE RACIAL AND ETHNIC HEALTH DISPARITIES(2004) McDonough, John E; Gibbs, Brian K; Scott-Harris, Janet L; Kronebusch, Karl; Navarro, Amanda M; Taylor, KimaThis report provides state policymakers with a menu of policy interventions that have been implemented to address disparities in minority health and health care. The authors divide these state and local programs into those targeting infrastructure, management, and capacity, and those targeting specific health conditions. Based on their review, the authors identified eight key needs that state and national policymakers will need to consider: consistent racial/ethnic data collection; effective evaluation of disparities-reduction programs; minimum standards for culturally and linguistically competent health services; greater minority representation within the health care workforce; expanded health screening and access to services (e.g., through expanded insurance coverage); establishment or enhancement of state offices of minority health; involvement of all health system stakeholders in minority health improvement efforts; and creation of a national coordinating body to promote continuing state-based activities to eliminate racial and ethnic health disparities.