Racial/ethnic disparities in the use of preventive services among the elderly

OBJECTIVES: Minorities have worse health outcomes compared to whites, which are partially explained by racial/ethnic disparities in use of health services. Less well known, however, are whether these disparities persist among the elderly, the only group that possesses near universal health insurance coverage by Medicare, and how variation in Medicare coverage affects the receipt of preventive services. The scope of racial/ethnic disparities in the use of preventive services in the elderly was assessed, and the impact of the type of health insurance coverage on the use of preventive services was measured. METHODS: Data were derived from the 2001 California Health Interview Survey, a random-digit-dial population-based survey, collected between November 2000 and October 2001. Analysis for this project was conducted in 2004. The association of race/ethnicity and type of health insurance with receipt of preventive services was assessed using bivariate and multivariate logistic regression models. RESULTS: African Americans and Latinos were significantly less likely to be vaccinated for influenza, and Asian Americans were significantly less likely to obtain a mammogram compared to whites, while controlling for other explanatory factors. Moreover, those with Medicare plus Medicaid coverage were significantly less likely to use all four preventive services compared to those with Medicare plus private supplemental insurance. CONCLUSIONS: Despite near-universal coverage by Medicare, racial/ethnic disparities in the use of some preventive services among the elderly persist. Further research should focus on identifying potential cultural and structural barriers to receipt of preventive services aimed at designing effective intervention among high-risk groups.     

Racial/ethnic disparities in adult preventive dental care use

Using the Behavioral Model of Health Services Utilization, this study examines whether adult preventive dental care utilization differs by ethnicity/race. Logistic regression results find that controlling only for predisposing characteristics (gender, age, education, and health status), African Americans, Mexican Americans, and Other race/ethnicity are less likely than whites to utilize dental services. However, the effects are no longer significant when enabling resource variables are included in the model (income level, insurance, census region, and metropolitan statistical area). Interactions between race/ethnicity and insurance status show that privately insured racial/ethnic minority groups do not differ from privately insured whites in their utilization of dental services. Similarly, the preventive dental care utilization of publicly insured African Americans and Other Hispanics does not differ significantly from privately insured whites. However, publicly insured whites, Mexican Americans, and individuals of Other race/ethnicity have significantly lower odds of utilizing dental services relative to whites with private insurance.     

County characteristics and racial and ethnic disparities in the use of preventive services

BACKGROUND: Studies examining predictors of preventive service utilization generally focus on individual characteristics and ignore the role of contextual variables. To help address this gap in the literature, the present study investigates whether county-level characteristics, such as racial and ethnic composition, are associated with the use of preventive services. METHODS: Data from the Medical Expenditure Panel Survey and the Area Resource Files (1996-1998) are used to identify the individual- and county-level predictors of five types of preventive services (n = 49,063). RESULTS: County racial or ethnic composition is associated with the utilization of certain preventive services, net of individual-level characteristics. Specifically, individuals in high percent Hispanic counties are more likely to report cholesterol screenings, while those in counties with more blacks are more likely to have regular mammograms. Moreover, county racial or ethnic composition modifies the relationship between individual race or ethnicity and preventive use. In particular, Hispanic individuals who reside in high percent black counties report higher levels of utilization for most preventive services compared to Hispanics living in other counties. CONCLUSIONS: Physical and social environments are key determinants of health behaviors and outcomes. Future studies should take into account the racial or ethnic composition of an area and how this interacts with individual race or ethnicity when investigating predictors of preventive care use.     

Racial/ethnic disparities in the use of mental health services in poverty areas

OBJECTIVES: This study examined racial/ethnic disparities in mental health service access and use at different poverty levels. METHODS: We compared demographic and clinical characteristics and service use patterns of Whites, Blacks, Hispanics, and Asians living in low-poverty and high-poverty areas. Logistic regression models were used to assess service use patterns of minority racial/ethnic groups compared with Whites in different poverty areas. RESULTS: Residence in a poverty neighborhood moderates the relationship between race/ethnicity and mental health service access and use. Disparities in using emergency and inpatient services and having coercive referrals were more evident in low-poverty than in high-poverty areas. CONCLUSIONS: Neighborhood poverty is a key to understanding racial/ethnic disparities in the use of mental health services.     

Racial and ethnic disparities in HIV/AIDS, sexually transmitted diseases, and tuberculosis among women

Disparities in health status and health outcomes exist among subpopulations of women; these disparities may be related to socioeconomic status, race, ethnicity, and country of birth. In this paper, we use surveillance data from 2003 and earlier to examine racial and ethnic differences among women in sexually transmitted diseases (STDs) (chlamydia, gonorrhea, and syphilis), human immunodeficiency virus (HIV), and tuberculosis. We also describe prevention programs the Centers for Disease Control and Prevention (CDC) has developed to address the disparities.     

Acculturation, access to care and use preventive health services by Vietnamese women

PURPOSE OF THE PAPER. The purposes of this study were to examine the relationships between acculturation and (1) access to health services and (2) use of preventive services among Vietnamese women in western Massachusetts. METHODS. The telephone survey method was conducted with 141 Vietnamese women ages 18 years or over. PRINCIPAL FINDINGS. Of the acculturation variables, language acculturation was significantly related to having a routine place for health care and a regular provider. Women tended to have better access to health service with an increase in the length of residence in the US. Length of residence in the US was an independent predictor of prior use of Pap test and clinical breast examination. CONCLUSIONS. Utilization level of preventive health services among study group participants was low. The findings indicate that length of residence and increase in language capacity (more English usage) lead to more adequate access to health care. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS. This study is particularly relevant to Vietnamese American women in the U.S. KEY WORDS. Vietnamese women; acculturation; preventive heaslth services; Massachusetts.     

Cultural and educational disparities in the use of primary and preventive health care services among midlife women in Israel.

PURPOSE: This study aimed to assess rates of primary and preventive healthcare use among women in midlife from different cultural origins and to identify sociodemographic and health characteristics that could explain cultural differences in health care utilization. METHODS: Data were collected for the Women's Health in Midlife National Study in Israel, in which women aged 45-64 were randomly selected according to age and ethnic/origin group strata: Long-term Jewish residents (n = 540), immigrants from the former Soviet Union (n = 151), and Arab women (n = 123). Interviews included measures of primary and preventive visits, clinical screening services (mammogram, Pap smear, bone density), health and lifestyle, and sociodemographics. MAIN FINDINGS: Long-term residents reported more preventive visits and screening tests and lower use of primary care, compared with immigrants and Arab women. In multivariate analyses, cultural group, education, self-rated health, and health motivation were significantly associated with utilization of primary and preventive care. Ethnic/origin group differences were mostly related to cultural differences and not to financial barriers or medical factors. For example, among the more traditional group, namely, Arab women, low use of preventive gynecologic care seemed to be related to the lack of physicians of the same culture and gender. CONCLUSIONS: The findings underscore the importance of the primary care physician, especially in minority groups, as a provider who can identify at-risk groups and serve as a gateway to health promotion. The findings also suggest that the lack of female providers may be one explanation for the low utilization of gynecologic services among women from traditional cultures.     

Racial and socioeconomic disparities in breastfeeding--United States, 2004

The American Academy of Pediatrics recommends breastfeeding for at least the first year of life, and beyond for as long as mutually desired by mother and child. Not breastfeeding is associated with increased health risks for children, including otitis media, respiratory tract infections, diarrhea, and necrotizing enterocolitis. In addition, breastfeeding duration is inversely associated with risk for childhood overweight. Breastfeeding also is associated with health benefits for mothers, including reduced risk for ovarian cancer and premenopausal breast cancer. Breastfeeding rates differ substantially by race, socioeconomic level, and other demographic factors. For example, among children born during 1982-1993, non-Hispanic black children were less likely than non-Hispanic white children to be breastfed at birth and at age 6 months, even when comparisons were among children in the same socioeconomic or other demographic subgroup. To obtain current estimates of racial and economic disparities in breastfeeding among U.S. children, CDC analyzed data from the 2004 National Immunization Survey (NIS). This report describes the results of that analysis, which indicated that 71.5% of non-Hispanic white children were ever breastfed compared with 50.1% of non-Hispanic black children. Among those ever breastfed, 53.9% of non-Hispanic white and 43.2% of non-Hispanic black children continued breastfeeding until at least age 6 months. Disparities between black and white children existed within most socioeconomic subgroups studied. Public health programs should continue to promote breastfeeding initiation and increase support of breastfeeding continuation, especially among subgroups with the lowest rates (i.e., black, poor, and young mothers; mothers with less than a high school education; and mothers residing in rural areas).     

Racial/ethnic disparities in nursing

The racial and ethnic composition of the registered nurse (RN) workforce in California is not at parity with the composition of the population. We find that the underrepresentation of African Americans in nursing in California appears to be due to lower overall educational attainment among African Americans. Underrepresentation of Latinos is due to lower overall educational attainment and, to a lesser extent, a lower percentage of college-educated Latinos pursuing careers in nursing. Improving the overall educational attainment of minority students is critical to increasing the number of minorities in nursing.     

Pregnancy experiences of women in rural Romania: understanding ethnic and socioeconomic disparities

Women in rural Romania face significant health disadvantages. This qualitative pilot study describes the structural disadvantage experienced during pregnancy by women in rural Romania, focusing on the lived experiences of Roma women. We explore how women in rural communities experience pregnancy, their interactions with the healthcare system, and the role that ethnic and social factors play in pregnancy and childbearing. We conducted 42 semi-structured interviews with health and other professionals, seven narrative interviews with Roma and non-Roma women and a focus group with Roma women. Data were analysed using thematic analysis. We identified intersectional factors associated with women’s pregnancy experiences: women perceiving pregnancy as both unplanned and wanted, joyful, and normal; women’s and professionals’ differing prenatal care perceptions; transport and cost related barriers to care; socioeconomic and ethnic discrimination; and facilitators to care such as social support, having a health mediator and having a doctor. Talking directly with professionals and Roma and non-Roma women helped us understand these many factors, how they are interconnected, and how we can work towards improving the pregnancy experiences of Roma women in rural Romania.     

Racial/ethnic and socioeconomic disparities in multiple risk factors for heart disease and stroke--United States, 2003

Heart disease and stroke are the first and third leading causes of death, respectively, in the United States. Certain modifiable risk factors, including high blood pressure, high cholesterol, diabetes, tobacco use, obesity, and lack of exercise, are the main targets for primary and secondary prevention of heart disease and stroke. A substantial proportion of the population has multiple risk factors, increasing their likelihood of cardiovascular disease. To assess the prevalence of multiple risk factors for heart disease and stroke and to identify disparities in risk status among population subgroups, CDC analyzed data from the 2003 Behavioral Risk Factor Surveillance System (BRFSS) survey. This report summarizes the results of that analysis, which indicated that approximately 37% of the survey population had two or more risk factors for heart disease and stroke and that considerable disparities in risk factors existed among socioeconomic groups and racial/ethnic populations. To decrease morbidity and mortality from heart disease and stroke, public health programs should improve identification of persons with multiple risk factors and focus interventions on those populations disproportionately affected.     

Racial and socioeconomic disparities in arterial stiffness and intima media thickness among adolescents

Racial and socioeconomic status (SES) disparities in cardiovascular disease (CVD) risk are well established among adults. However, little is known about disparities in CVD risk among adolescents, particularly considering indices of subclinical CVD. Our aim was to examine socioeconomic and racial disparities in subclinical CVD indices among adolescents. We hypothesized that African American and lower SES adolescents would show greater arterial stiffness and intima media thickness compared to Caucasian and higher SES adolescents, respectively. Participants were 81 African American and 78 Caucasian adolescents (mean age = 17.8) from two schools in Pittsburgh, PA, USA. Measures of subclinical CVD were pulse wave velocity and intima media thickness, as assessed by Doppler and B-mode ultrasound, respectively. SES indices included parental education, family income, family assets, subjective social status, and census-derived neighborhood SES. Hypotheses were evaluated in multiple linear regression models with the covariates age, gender, body mass index, and systolic blood pressure. Results indicated that African American adolescents were more often in low SES positions than Caucasians. When considered individually, racial and SES disparities in pulse wave velocity, and to a lesser extent, intima media thickness, were evident. When race and SES were considered together, high school education, low or medium income, and low neighborhood SES were associated with higher pulse wave velocity. Fewer assets were associated with higher intima media thickness. In conclusion, racial and SES disparities in indices of subclinical CVD were observed, with findings most pronounced for SES disparities in pulse wave velocity. This study extends previous findings in adults to adolescents, indicating that disparities in arterial stiffness and intima media thickness occur as early as adolescence. Efforts to reduce socioeconomic and racial disparities in CVD should target disparities early in life.     

Racial/ethnic disparities in symptom severity among children hospitalized with asthma

Asthma is the most common chronic illness among U.S. children as well as a leading cause of hospitalization and functional disability. This cross-sectional study uses 2001 hospitalization data for Pennsylvania to examine disparities among Black, Hispanic, and White children in asthma symptomatology at the time of admission. Compared with Whites, Black children were over twice as likely to have the most severe asthma symptoms, taking into account age, sex, insurance status, income, and rural/urban residence. Increased likelihood of severe clinical condition at admission was also independently associated with Medicaid coverage, with older age at admission, and with urban residence. The relationship between symptom severity at presentation in the emergency department and access to and utilization of appropriate ambulatory care services for children with asthma warrants further investigation.