Pap smear use in California: are we closing the racial/ethnic gap?

BACKGROUND: Minority women continue to be disproportionately affected by cervical cancer. Minority population groups at high risk for cervical cancer may be failing to fully comply with screening recommendations. The use of Pap smears among women in California was evaluated to identify ethnic groups at higher risk for noncompliance with cervical cancer screening. METHODS: Cross-sectional analysis of 2001 California Health Interview Survey data. Logistic regression was used to assess the independent contribution of race/ethnicity to the use of Pap smears. RESULTS: Hispanic (aPR = 1.03, 95% CI 1.02-1.05) and Black (aPR = 1.03, 95% CI 1.001-1.06) women are more likely to report a Pap smear in the past 3 years as compared to White women. Asians were the least likely to report cervical cancer screening despite a more favorable sociodemographic profile. Screening rates varied among Hispanic or Asian subgroups; Mexicans, Vietnamese, Chinese, and South Asians are particularly underserved. CONCLUSIONS: In contrast to the country as a whole, Hispanic women in California are more likely to report a recent Pap smear as compared to White women. However, racial/ethnic disparities in Pap smear use persist; Asian women are the least likely to report cervical cancer screening as compared to any other group.     

Contextual analysis of breast and cervical cancer screening and factors associated with health care access among United States women, 2002

This research explored the relationships between race/ethnicity and area factors affecting access to health care in the United States. The study represents an advance on previous research in this field because, in addition to including data on rurality, it incorporates additional contextual covariates describing aspects of health care accessibility. Individual-level data were obtained from the 2002 Behavioral Risk Factor Surveillance System (BRFSS). The county of residence reported by BRFSS respondents was used to link BRFSS data with county-level measures of health care access from the 2004 Area Resource File (ARF). Analyses of mammography were limited to women aged 40 years with known county of residence (n=91,492). Analyses of Pap testing were limited to women aged 18 years with no history of hysterectomy and known county of residence (n=97,820). In addition to individual-level covariates such as race, Hispanic ethnicity, health insurance coverage and routine physical exam in the previous year. We examined county-level covariates (residence in health professional shortage area, urban/rural continuum, racial/ethnic composition, and number of health centers/clinics, mammography screening centers, primary care physicians, and obstetrician-gynecologists per 100,000 female population or per 1000 square miles) as predictors of cancer screening. Both individual-level and contextual covariates are associated with the use of breast and cervical cancer screening. In the current study, covariates associated with health care access, such as health insurance coverage, household income, Black race, and percentage of county female population who were non-Hispanic Black, were important determinants of screening use. In multivariate analysis, we found significant interactions between individual-level covariates and contextual covariates. Among women who reside in areas with lower primary care physician supply, rural women are less likely than urban women to have had a recent Pap test. Black women were more likely than White women to have had a recent Pap test. Women with a non-rural county of residence were more likely to have had a recent mammogram than rural women. A significant interaction was also found between individual-level race and number of health centers or clinics per 100,000 population (p-value=0.0187). In counties with 2 or more health centers or clinics per 100,000 female population, Black women were more likely than White women to have had a recent mammogram. A significant interaction was also observed between the percentage of county female population who were Hispanic and the percentage who were non-Hispanic Black.     

Endometrial cancer: socioeconomic status and racial/ethnic differences in stage at diagnosis, treatment, and survival

OBJECTIVE: We evaluated the association between socioeconomic status and racial/ ethnic differences in endometrial cancer stage at diagnosis, treatment, and survival. METHODS: We conducted a population-based study among 3656 women. RESULTS: Multivariate analyses showed that either race/ethnicity or income, but not both, was associated with advanced-stage disease. Age, stage at diagnosis, and income were independent predictors of hysterectomy. African American ethnicity, increased age, aggressive histology, poor tumor grade, and advanced-stage disease were associated with increased risk for death; higher income and hysterectomy were associated with decreased risk for death. CONCLUSIONS: Lower income was associated with advanced-stage disease, lower likelihood of receiving a hysterectomy, and lower rates of survival. Earlier diagnosis and removal of barriers to optimal treatment among lower-socioeconomic status women will diminish racial/ethnic differences in endometrial cancer survival.     

Factors associated with racial/ethnic differences in colorectal cancer screening

Introduction: Racial/ethnic differences in colorectal cancer (CRC) screening rates are thought to account, in part, for the racial/ethnic differences in CRC disease burden. The purpose of this study was to examine which factors mediate racial/ethnic differences in CRC screening. METHODS: Five hundred sixty participants attending a primary care clinic, aged 50 to 80 years, and of African-American, Hispanic, or non-Hispanic white race/ethnicity were interviewed. The goal was to assess the contribution of sociodemographic characteristics, knowledge, beliefs about CRC, and the health care experience with their primary care doctor to racial/ethnic differences in CRC screening. The outcome variable was self-reported screening. All analyses were weighted; bivariate testing and multivariate logistic regression was conducted. RESULTS: The response rate was 55.7%, with no sociodemographic differences noted between respondents and nonrespondents. Respondents were African-American (n = 194), Hispanic (n = 162), and non-Hispanic white (n = 204); 64.5% were aged 50 to 64 years; 63.1% were women; 96.9% were insured; and over half reported a total annual income of less than $25,000. Overall 62.5% were current with CRC screening: 67.5% of non-Hispanic whites, 54.3% of African-Americans, and 48.6% of Hispanics (P < .001). A doctor's recommendation (odds ratio, 3.86); awareness of screening (odds ratio, 3.32); older age (odds ratio, 2.88); greater education (odds ratio, 2.02); and perceived susceptibility (odds ratio, 1.74) contributed to racial/ethnic differences in CRC screening. CONCLUSIONS: Interventions to address CRC screening disparities among racial/ethnic groups should focus on the health care setting and patient education about CRC screening; differences in attitudes and beliefs seem to be less important.     

Maternal age and parity-associated risks of preterm birth: differences by race/ethnicity

There is a well-known interaction between maternal age and parity in the risk of adverse perinatal outcomes, including preterm birth (PTB), such that young multiparae and older primiparae have greater risks. Yet it is not known whether this interaction varies by race/ethnicity. US birth records for singleton births from 2000 to 2002 were used to examine the incidence of PTB by maternal age and parity within non-Hispanic White, non-Hispanic Black and Hispanic subgroups. PTB was categorised as moderately (32-36 weeks), very (28-31 weeks), or extremely (<28 weeks) preterm. Odds ratios of PTB according to age and parity were calculated in racial/ethnic specific multinomial logistic regression models. Within each race/ethnicity, comparisons were made relative to 25- to 29-year-old primiparae. Young teenagers (<18), particularly multiparae, generally had a higher risk of each degree of PTB among all three racial/ethnic groups. However, Black teenagers did not have a higher risk of extremely PTB. For very and extremely PTB, teenagers had considerably higher risk among Whites than Blacks or Hispanics. Within each racial/ethnic group, older (35+ years) primiparae had similarly higher risk of each category of PTB relative to 25- to 29-year-old primiparae. Older multiparae had higher risk of moderately and very PTB among Black and Hispanic women only. Adjustment for education did not alter these findings. Teenagers and older primiparae are already widely regarded as having greater perinatal risks. This study suggests that, among Black and Hispanic women, older multiparae may also have a higher risk of moderately and very PTB.     

Racial/ethnic variation in breastfeeding across the US: a multilevel analysis from the National Survey of Children's Health, 2007

We examined whether differences across states in race/ethnicity-specific breastfeeding rates are due solely to state differences in individual factors associated with breastfeeding or additionally, certain state "contextual" factors. Using data from the 2007 National Survey of Children's Health, multilevel models examined whether state variability in race/ethnicity specific breastfeeding initiation and duration to 6 months were explained by (1) individual sociodemographic characteristics of women in states, and (2) an aggregate state measure of the availability of evidence-based maternity care services related to breastfeeding. Observed variability of race/ethnicity-specific breastfeeding rates was only minimally reduced after adjusting for sociodemographic characteristics (Median Odds Ratios (MOR), breastfeeding initiation: non-Hispanic White = 1.46, non-Hispanic Black = 2.26; Hispanic = 1.89. MOR, breastfeeding for 6 months: non-Hispanic White = 1.36, non-Hispanic Black = 1.84; Hispanic = 1.56). Overall variability in the degree of state gaps changed little in adjusted models (breastfeeding initiation: non-Hispanic Black σ(2) = 0.74, se 0.28, Hispanic σ(2) = 0.45, se 0.11; breastfeeding to 6-months: non-Hispanic Black σ(2) = 0.41, se 0.10, Hispanic σ(2) = 0.22, se 0.05). The measure of maternity care services was positively associated with breastfeeding overall but generally did not explain a substantial portion of between-state variability nor the overall variability in racial/ethnic gaps. Contextual sources of variation in state breastfeeding practices and disparities remain poorly understood. Differences in the socioeconomic makeup of states do not fully explain variability. The association of state breastfeeding rates and disparities with relevant policy and practice factors should be further investigated.     

Racial/ethnic heterogeneity in the socioeconomic patterning of CVD risk factors: in the United States: the multi-ethnic study of atherosclerosis

Many studies document racial variation, gender differences, and socioeconomic status (SES) patterning in cardiovascular disease (CVD) risk factors but few studies have investigated heterogeneity in SES differences by race/ethnicity or gender. Using data from the Multi-Ethnic Study of Atherosclerosis (N=6,814) and stratified regression models, we investigated race/ethnic differences in the SES patterning of diabetes, hypertension, smoking, and body mass index (BMI). Inverse socioeconomic gradients in hypertension, diabetes, smoking, and BMI were observed in White and Black women but associations were weaker or absent in Hispanic and Chinese women (except in the case of diabetes for Hispanic women). Even greater heterogeneity in social patterning of risk factors was observed in men. In White men all four risk factors were inversely associated with socioeconomic position, although often associations were only present or were stronger for education than for income. The inverse socioeconomic patterning was much less consistent in men of other races/ethnic groups, and higher SES was associated with higher BMI in non-White men. These findings have implications for understanding the causes of social patterning, for the analysis of SES adjusted race/ethnic differences, and for the targeting of interventions.     

Organochlorine exposures and breast cancer risk in New York City women

A hospital-based case-control study of breast cancer risk related to organochlorine (OC) exposure was conducted in a multiethnic setting in New York City. We enrolled 175 breast cancer patients and 355 control patients. The overall racial/ethnic distribution was 57% Caucasian, 21% Hispanic, 22% African-American; cases and controls were frequency-matched by age and race/ethnicity. Tumor markers (estrogen and progesterone receptors, p53, erbB-2) were assessed and organochlorines (DDE, DDT, trans-nonachlor, and higher (HPCB) and lower (LPCB) chlorinated biphenyls) were measured in blood serum. Tumors among minority women were of slightly higher stage than among Caucasians, but tumor markers were similar across the racial/ethnic groups. DDE levels were highest among African-American and Hispanic women; DDT was highest among Hispanics; HPCBs were highest among African-Americans; LPCBs were lowest among Hispanics; and trans-nonachlor was highest among African-Americans. However, OC levels were not associated with risk for breast cancer, nor did OCs differ with respect to tumor stage or tumor markers. Higher DDE levels were associated with increasing body mass index (BMI), but with decreasing level of education, frequency of nulliparity, and frequency of family history of breast cancer. HPCB levels decreased with BMI and were not correlated with breast cancer risk factors. These relationships can be attributed to historical patterns of exposure and to metabolic differences in OCs related to BMI.     

Disparities in Sexually Transmitted Infection/HIV Testing,Contraception, and Emergency Contraception Care Among Adolescent Sexual Minority Women Who Are Racial/Ethnic Minorities

PurposeSexual minority women and racial/ethnic minority women in the United States are at increased risk for sexually transmitted infections (STIs) and unintended pregnancy. Yet, we know little about STI/HIV testing and contraceptive care among women who have sex with women only and women who have sex with both women and men, and who are racial/ethnic minorities. This study examined receipt of STI/HIV testing and contraceptive care among sexually active adolescent women by sex of sexual contact(s) and race/ethnicity.MethodsOur sample included 2,149 sexually active adolescent women from the National Survey of Family Growth (2011–2019). We examined receipt of sexual and reproductive health (SRH) services by sex of sexual contact(s) and race/ethnicity: STI and HIV testing, contraceptive counseling, contraceptive method, emergency contraception (EC) counseling, and EC method.ResultsService receipt was low for all adolescent women, with disparities by sex of sexual contact(s) and by race/ethnicity. Women who have sex with women only had the lowest rates across all services; women who have sex with both women and men had higher rates of STI and HIV testing and EC counseling than women who have sex with men only. Non-Hispanic Black women had higher rates of STI and HIV testing than non-Hispanic White peers, and non-Hispanic Black and Hispanic women had lower rates of contraception method receipt than their non-Hispanic White peers. Racial/ethnic disparities persisted when results were stratified by sex of sexual contact(s).DiscussionThere is an unmet need for improved SRH service delivery for all adolescent women and for services that are not biased by sex of sexual contact(s) and race/ethnicity.     

Explaining racial disparities in HIV/AIDS incidence among women in the U.S.: a systematic review

Surveillance data indicate that HIV incidence among Black women is more than 20 times that among White women and more than 4 times that among Hispanic women. Several studies have examined HIV risk factors by race/ethnicity including high-risk sex, drug use, inconsistent disclosure of same-sex behavior by male partners, and sexually transmitted diseases (STDs). We formed these risk factors into four hypotheses that attempt to explain the higher incidence of HIV infection among Black women. We further conducted a literature review by searching three online databases for studies published between 1985 and 2006 addressing the four hypotheses. Literature suggests that Black women are no more likely to have unprotected sex, have multiple sexual partners, or use drugs than women of other racial/ethnic groups. However, some studies suggest that Black women are more likely to have risky sex partners and STDs. We also found that Black men are less likely to disclose their same-sex behavior to female partners. These four hypotheses are insufficient in explaining the greater burden of HIV among Black women. Future investigations should continue to explore these and other social and behavioral factors such as poverty, health-care access, and receptivity to prevention messages to explain racial/ethnic disparities in HIV incidence.     

Predictors of cancer screening among low-income primary care patients

Although population-based studies report lower rates of cancer screening among racial/ethnic minorities than among Whites in the U.S., few studies have examined predictors of screening among low-income Hispanic, Black, and Chinese primary care patients. We examined utilization of mammography, Pap smear, digital rectal examination, fecal occult blood testing, sigmoidoscopy/colonoscopy, and prostate-specific antigen testing in 833 patients from 2 community health centers in New York City, ascertaining relationships between use of screening and race/ethnicity, income, education, years in the U.S., insurance, cancer risk perception, family disease history, and physician recommendation. Despite similar access to primary care, Hispanics and Blacks reported higher utilization rates of all screening tests than Chinese (p<.01). Physician recommendation and more years in the U.S. were associated with greater use of all screening services (p<.001), with physician recommendation most strongly associated with screening. Interventions to enhance screening by at-risk groups should emphasize both physician recommendation and culturally-sensitive patient education.     

Preconception Health Risks Among U.S. Women: Disparities at the Intersection of Disability and Race or Ethnicity

IntroductionPrior research has found that some preconception health risks are more prevalent among women in historically minoritized racial and ethnic groups. Preconception health risks are also increased among women with disabilities. Risks could be even greater among women who both have a disability and belong to a minoritized racial or ethnic group. The purpose of this study was to assess preconception health at the intersection of disability and race or ethnicity.MethodsWe analyzed data from the 2016 Behavioral Risk Factor Surveillance System to estimate the prevalence of health behaviors, health status indicators, and preventive healthcare receipt among nonpregnant women 18–44 years of age. We used modified Poisson regression to compare non-Hispanic White women with disabilities and women with and without disabilities in three other race/ethnicity groups (non-Hispanic Black, Hispanic, other race) to a reference group of non-Hispanic White women without disabilities. Disability status was defined based on affirmative response to at least one of six questions about difficulty with seeing, hearing, mobility, cognition, personal care, or independent living tasks. Multivariate analyses adjusted for other sociodemographic characteristics such as age and marital status.ResultsIn every racial and ethnic group, women with disabilities had a significantly higher prevalence of most preconception health risks than their counterparts without disabilities. The disparity in obesity for Black women with disabilities was additive, with the adjusted prevalence ratio (PR, 1.77; 95% confidence interval [CI], 1.57–2.00) equal to the sum of the prevalence ratios for disability alone (PR, 1.29; 95% CI, 1.19–1.41) and Black race alone (PR, 1.47; 95% CI, 1.36–1.58).ConclusionsWomen at the intersection of disability and minoritized race or ethnicity may be at especially high risk of adverse outcomes. Targeted efforts are needed to improve the health of women of reproductive age in these doubly marginalized populations.     

Gender differences across racial and ethnic groups in the quality of care for acute myocardial infarction and heart failure associated with comorbidities.

This paper provides important insights on gender differences across racial and ethnic groups in a Medicare population in terms of the quality of care received for acute myocardial infarction (AMI) and congestive heart failure (CHF) in association with diabetes or hypertension/end-stage renal disease (ESRD). Both race/ethnicity and gender are associated with differences in the diagnostic evaluation and treatment of Medicare recipients with these conditions. In the AMI group, non-Hispanic Black and Hispanic patients of both genders were less likely to receive aspirin or beta-blockers than non-Hispanic Whites. These differences persisted for Hispanic women and men even when they presented with ESRD or diabetes. Rates for smoking cessation counseling were among the lowest among non-Hispanic Blacks and Hispanics with AMI-diabetes and non-Hispanic blacks with AMI-hypertension/ESRD. Gender comparisons within racial groups for the AMI and AMI-diabetes groups show that among non-Hispanic Whites, women were less likely to receive aspirin and beta-blockers. No gender differences were noted among non-Hispanic Black and Hispanic Medicare recipients. In the CHF group, Hispanics were the racial/ethnic group least likely to have an assessment of left ventricular function (LVF), even if they had diabetes and had lower rates of angiotensin-converting enzyme inhibitor therapy or even if they had combined CHF-hypertension/ESRD. Gender comparisons in both the CHF and CHF-hypertension/ESRD groups show that non-Hispanic White women were less likely to have an LVF assessment than non-Hispanic White men. Among all subjects, having comorbidities with AMI was not associated with higher markers of quality cardiovascular care. Closing the many gaps in cardiovascular care must target the specific needs of women and men across racial and ethnic groups.     

Trends in colorectal cancer screening disparities in people aged 50-64 years, 2000-2005

BACKGROUND: Colorectal cancer (CRC) screening rates are low, and racial, ethnic, and economic disparities have been reported. Whether disparities in CRC screening have decreased over time is unknown. This study aimed to determine whether progress was made between 2000 and 2005 in reducing CRC screening disparities by race, ethnicity, income, and insurance status. METHODS: Age-adjusted percentages of participants aged 50-64 who reported CRC screening (home fecal occult blood test in the past year or endoscopy in the past 10 years) were estimated from the 2000 (n=6020 participants) and 2005 (n=6706) cancer control supplements of the National Health Interview Survey, with analysis in 2007. RESULTS: Screening rates did not increase between 2000 and 2005 for Hispanic women or uninsured women. Only for high-income participants did screening exceed 50%. For both men and women, the uninsured had the lowest levels of screening (19.1% and 19.3%, respectively, in 2005), and the greatest disparities were observed among groups defined by health insurance status. For women, disparities by ethnicity, income, and insurance status increased over time, whereas among men, disparities in 2005 were similar to those in 2000. For Hispanic women, growing disparities were present at all income and insurance levels and persisted after additional adjustment. CONCLUSIONS: No progress was made in reducing most CRC screening disparities between 2000 and 2005. Methods are needed to increase CRC screening among everyone, but in particular Hispanic women and uninsured men and women.     

Institutional variation in the promotion of racial/ethnic minority faculty at US medical schools

Objectives. We compared faculty promotion rates by race/ethnicity across US academic medical centers.Methods. We used the Association of American Medical College''s 1983 through 2000 faculty roster data to estimate median institution-specific promotion rates for assistant professor to associate professor and for associate professor to full professor. In unadjusted analyses, we compared medians for Hispanic and Black with White faculty using the Wilcoxon rank sum test. We compared institution-specific promotion rates between racial/ethnic groups with data stratified by institutional characteristic (institution size, proportion racial/ethnic minority faculty, and proportion women faculty) using the χ² test. Our sample included 128 academic medical centers and 88 432 unique faculty.Results. The median institution-specific promotion rates for White, Hispanic, and Black faculty, respectively, were 30.2%, 23.5%, and 18.8% (P < .01) from assistant to associate professor and 31.5%, 25.0%, and 16.7% (P < .01) from associate to full professor.Conclusions. At most academic medical centers, promotion rates for Hispanic and Black were lower than those for White faculty. Equitable faculty promotion rates may reflect institutional climates that support the successful development of racial/ethnic minority trainees, ultimately improving healthcare access and quality for all patients.The racial/ethnic composition of the healthcare workforce does not reflect the diversity in the US general population. Although combined Blacks and Hispanics represent 28.7% of the total US population,1 only 8.4% of all practicing US physicians are Black or Hispanic.2,3 These disparities extend to academic medical center faculty. Historically underrepresented racial/ethnic minorities constitute 7% of all current academic medical center faculty and fewer than 5% of all new academic medical center faculty.2,4The rationale for supporting racial/ethnic diversity across the academic medical center faculty workforce is multifold. Faculty diversity increases the quality of training for all students, and racial/ethnic minority faculty often serve as important professional resources for racial/ethnic minority trainees.5,6 This is a critical role within the social mission of academic medical centers to develop a diverse practicing physician workforce, which is necessary to reduce healthcare discrimination and increase healthcare access and quality.7–9 Racial/ethnic minority faculty also often provide leadership in medical education, health policy, and research scholarship related to racial/ethnic health inequities. Despite these benefits, academic medical centers struggle to retain racial/ethnic diversity across faculty ranks.Institutional discrimination in the promotion process has been suggested as a potential explanation for the persistent lack of diversity at the senior faculty level associate professor and full professor ranks.10 The majority of Black and Hispanic academic medical center faculty are concentrated at the assistant professor level; among all racial/ethnic groups, men are more likely than are women to hold full professor rank.4 Aggregated national data have described lower career satisfaction among racial/ethnic minority academic medical center faculty, lower promotion rates compared with White peers despite adjustment for established measures of productivity, and decreased likelihood of being awarded research grants from the National Institutes of Health after controlling for several key factors.10–14 Other research has concluded that many physician academic medical center faculty, particularly racial/ethnic minorities, experience a poor institutional diversity climate or discrimination at work.15–18 Although recent data demonstrate increases in the overall numbers of first time racial/ethnic minority assistant professors and medical students,10,19 national averages that reveal lower and slower promotion rates for racial/ethnic minority faculty raise concerns about the success of organizational efforts to successfully diversify the academic medical center faculty workforce.10,13Despite consistent national data on differential career trajectories for racial/ethnic minority academic medical center faculty, it is unknown whether all academic medical centers face similar challenges in the promotion process. The Association of American Medical College''s Faculty Roster database provided us a unique opportunity to examine in detail the promotion disparities between racial/ethnic faculty at individual academic medical centers in the United States. We hypothesized that Black and Hispanic faculty would have lower rates of promotion to associate professor and full professor than would White faculty at most academic medical centers. We also sought to explore whether larger academic medical centers and academic medical centers with higher proportions of Black, Hispanic, or women faculty would approach promotion rate equity across faculty race/ethnicity.We estimated the median institution-specific faculty promotion rates by race/ethnicity across academic medical centers and described the proportion of academic medical centers with faculty promotion rate gaps by race/ethnicity. We also investigated whether selected institutional characteristics were associated with promotion rates for academic medical center faculty by race/ethnicity.     

Racial Variation in End‐of‐Life Intensive Care Use: A Race or Hospital Effect?

OBJECTIVE: To determine if racial and ethnic variations exist in intensive care (ICU) use during terminal hospitalizations, and, if variations do exist, to determine whether they can be explained by systematic differences in hospital utilization by race/ethnicity. DATA SOURCE: 1999 hospital discharge data from all nonfederal hospitals in Florida, Massachusetts, New Jersey, New York, and Virginia. DESIGN: We identified all terminal admissions (N = 192,705) among adults. We calculated crude rates of ICU use among non-Hispanic whites, blacks, Hispanics, and those with "other" race/ethnicity. We performed multivariable logistic regression on ICU use, with and without adjustment for clustering of patients within hospitals, to calculate adjusted differences in ICU use and by race/ethnicity. We explored both a random-effects (RE) and fixed-effect (FE) specification to adjust for hospital-level clustering. DATA COLLECTION: The data were collected by each state. PRINCIPAL FINDINGS: ICU use during the terminal hospitalization was highest among nonwhites, varying from 64.4 percent among Hispanics to 57.5 percent among whites. Compared to white women, the risk-adjusted odds of ICU use was higher for white men and for nonwhites of both sexes (odds ratios [ORs] and 95 percent confidence intervals: white men = 1.16 (1.14-1.19), black men = 1.35 (1.17-1.56), Hispanic men = 1.52 (1.27-1.82), black women = 1.31 (1.25-1.37), Hispanic women =1.53 (1.43-1.63)). Additional adjustment for within-hospital clustering of patients using the RE model did not change the estimate for white men, but markedly attenuated observed differences for blacks (OR for men =1.12 (0.96-1.31), women = 1.10 (1.03-1.17)) and Hispanics (OR for men =1.19 (1.00-1.42), women = 1.18 (1.09-1.27)). Results from the FE model were similar to the RE model (OR for black men = 1.10 (0.95-1.28), black women = 1.07 (1.02-1.13) Hispanic men = 1.17 (0.96-1.42), and Hispanic women = 1.14 (1.06-1.24)) CONCLUSIONS: The majority of observed differences in terminal ICU use among blacks and Hispanics were attributable to their use of hospitals with higher ICU use rather than to racial differences in ICU use within the same hospital.     

Racial Disparities in Access to Care for Men in a Public Assistance Program for Prostate Cancer

California's IMPACT program provides all its enrollees with health insurance and social service resources. We hypothesized that racial/ethnic disparities in access to care might be attenuated among men served by this program. Our objective was to evaluate racial/ethnic differences in health services utilization and patient-reported health care outcomes among disadvantaged men in a prostate cancer public-assistance program, and to identify modifiable factors that might explain persistent disparities in this health care setting. We performed a retrospective cohort study of 357 low-income men enrolled in IMPACT from 2001 through 2005. We evaluated realized access to care with two health services utilization measures: (1) use of emergency department care without hospitalization and, (2) frequency of prostate-specific antigen testing. We also measured two patient-experience outcomes: (1) satisfaction with care received from IMPACT, and (2) confidence in IMPACT care providers. We observed significant bivariate associations between race/ethnicity and patient-experience outcomes (P < 0.05), but not utilization measures. In multivariable models, Hispanic men were more likely than white men to report complete satisfaction with health care received in IMPACT (adjusted OR = 5.15, 95% CI 1.17-22.6); however, the association between race/ethnicity and satisfaction was not statistically significant (P = 0.11). Language preference and self-efficacy in patient-physician interactions are potentially-modifiable predictors of patient-experience outcomes. We observed no racial/ethnic disparities in health services utilization among disadvantaged men served by a disease-specific public assistance program. The greater satisfaction and confidence among Hispanic men are explained by modifiable variables that suggest avenues for improvement.     

Breast cancer size and stage in Hispanic American women, by birthplace: 1992-1995

OBJECTIVES: This study examined whether Hispanic women with breast cancer have tumor characteristics associated with delayed detection and whether these characteristics vary by birthplace. METHODS: Surveillance, Epidemiology, and End Results program data were used in examining breast cancer size and stage by racial/ethnic group and birthplace. RESULTS: Hispanic women with breast cancer had a higher percentage of tumors larger than 1 cm (77.7%) than--non-Hispanic Whites (70.3%), as well as a higher percentage of tumors larger than 2 cm (45.9% vs 33.0%). Furthermore, in comparison with Hispanic women born in the United States, Hispanic American women born in Latin America had higher percentages of tumors larger than 1 cm (82.2% vs 75.2%) and larger than 2 cm (54.1% vs 41.7%). CONCLUSIONS: These findings suggest that Hispanic women with breast cancer, especially first-generation Hispanic Americans, have a relative delay in the timeliness of their cancer diagnosis. First-generation Hispanic American women should be targeted in interventions designed to increase the use of breast cancer screening.