Racial differences in the elderly's use of medical procedures and diagnostic tests.

OBJECTIVES. This study sought to examine racial differences in the use of medical procedures and diagnostic tests by elderly Americans. METHODS. We used 1986 physician claims data for a 5% national sample of Medicare enrollees aged 65 years and older to study 32 procedures and tests. For each service, we calculated the age- and sex-adjusted rate of use by race and the corresponding White-Black relative risk. RESULTS. Whites were more likely than Blacks to receive 23 services, and for many of these services, the differences in use were substantial. In contrast, Blacks were more likely than Whites to receive seven services. Whites had a particular advantage in access to higher-technology or newer services. Racial differences in use persisted among elders who had Medicaid in addition to Medicare coverage and increased among rural elders. CONCLUSIONS. There are pervasive racial differences in the use of medical services by elderly Americans that cannot be explained by differences in the prevalence of specific clinical conditions. Financial barriers to care do not fully account for these findings. Race may exacerbate the impact of other barriers to access.     

Racial/ethnic differences in attitudes toward seeking professional mental health services

OBJECTIVES: This study examined racial/ethnic differences in attitudes toward seeking mental health services. METHODS: Data from the National Comorbidity Survey, which administered a structured diagnostic interview to a representative sample of the US population (N = 8098), were analyzed. Multiple logistic regression was used, and data were stratified by need for mental health services. RESULTS: African Americans with depression were more likely than Whites with depression to "definitely go" (odds ratio [OR] = 1.8, P < .001) seek mental health services. African Americans with severe psychiatric disorders were less likely to be "somewhat embarrassed if friends knew they sought care" (OR = 0.3, P < .001) than were their White counterparts. CONCLUSIONS: African Americans reported more positive attitudes toward seeking mental health services than did Whites.     

Racial differences in reported Lyme disease incidence

In the United States, the incidence of Lyme disease is considered to be disproportionately high among Whites because of risk of exposure. For assessment of racial differences in Lyme disease incidence and the role of risk exposure, incidence rate ratios (IRRs) for Lyme disease and its manifestations between Whites and African Americans in Maryland and in its focus of endemicity, the Upper Eastern Shore, were calculated. Calculations were based on reported cases of Lyme disease in Maryland during the years 1992-1996. The IRR for Lyme disease between Whites and African Americans was 6.3 (95% confidence interval (CI): 5.0, 8.0), decreasing to 1.8 (95% CI: 1.2, 2.7) for the Upper Eastern Shore. Statewide, there was a significant difference between the White to African American IRR for erythema migrans and for Lyme disease-associated arthritis, at 17.7 (95% CI: 11.2, 27.8) and 2.3 (95% CI: 1.7, 3.2), respectively. On the Upper Eastern Shore, the IRR for arthritis reversed, indicating higher incidence among African Americans than among Whites: IRR = 5.7 (95% CI: 2.4, 13.9) for erythema migrans and IRR = 0.7 (95% CI: 0.4, 1.1) for arthritis. White patients were more likely to have erythema migrans (risk ratio = 2.8, 95% CI: 1.9, 4.1) and less likely to have arthritis than were African Americans (risk ratio = 0.4, 95% CI: 0.3, 0.5). Among all patients, there was a significant negative association between arthritis and erythema migrans. Although much of the racial disparity in incidence rates diminishes in a rural, endemic area, consistent with exposure risk being responsible for much of the variation, a difference remains. This may be due to failure to recognize early disease (erythema migrans) among African Americans, resulting in increased rates of late manifestations. Geographic spread of the disease warrants efforts to increase awareness of Lyme disease and its manifestations among people of color and the health care providers who serve them.     

Racial differences in cardiac catheterization as a function of patients' beliefs

OBJECTIVES: We examined racial differences in cardiac catheterization rates and reviewed whether patients' beliefs or other variables were associated with observed disparities. METHODS: We did a prospective observational cohort study of 1045 White and African American patients at 5 Veterans Affairs (VA) medical centers whose nuclear imaging studies indicated reversible cardiac ischemia. RESULTS: There were few demographic differences between White and African American patients in our sample. African Americans were less likely than Whites to undergo cardiac catheterization. African Americans were more likely than Whites to indicate a strong reliance on religion and to report racial and social class discrimination and were less likely to indicate a generalized trust in people but did not differ from White patients on numerous other attitudes about health and health care. Neither sociodemographic or clinical characteristics nor patients' beliefs explained the observed disparities, but physicians' assessments of the procedure's importance and patients' likelihood of coronary disease seemed to account for differences not otherwise explained. CONCLUSIONS: Patients' preferences are not the likely source of racial disparities in the use of cardiac catheterization among veterans using VA care, but physicians' assessments warrant further attention.     

Health Disparities And Prevention: Racial/ethnic Barriers To Flu Vaccinations

To address the widening disparity between Whites and non-Whites for influenza vaccination rates, this study employed the Health Belief Model to examine these rates in five racial ethnic groups (White, Latino, African American, Filipino American, and Japanese American) to identify modifiable determinants of vaccination by race/ethnicity. A 2004 telephone survey of parishioners of faith-based congregations aged 50–75 years in Los Angeles and Honolulu assessed influenza vaccination rate, perceived susceptibility to influenza, perceived severity of illness, and the self-reported main barrier to influenza vaccination. Logistic regression models for each race/ethnic group predicting vaccination dependent upon perceived susceptibility to influenza, perceived severity of illness, and sociodemographic characteristics were estimated. Model parameters were used to generate standardized predictions of vaccination rates by race/ethnic group. In the multivariate models, Whites and African Americans who were very concerned about getting the flu were significantly more likely to be vaccinated (96% and 91%, respectively), compared with those who were not concerned (45% and 33%). However, vaccination rates among Latinos who were very concerned about getting the flu (54%), although significantly higher than Latinos who were not concerned (34%), were lower than for Whites and African Americans. Examination of the main barriers to vaccination revealed that Latinos were more likely to report access and cost barriers, while African Americans were more likely to raise issues of mistrust such as concern that the vaccine causes influenza. Distinct barriers to influenza vaccination exist among racial/ethnic groups. Vaccination programs may benefit from addressing these specific and unique concerns.     

Health information seeking and use outside of the medical encounter: Is it associated with race and ethnicity?

Increasing numbers of adults in the United States of America (USA) are seeking and using health information within their medical encounters. The theory of uncertainty management suggests that patients reduce health care uncertainty by increasing their understanding of disease etiology or treatment options, improving patient–doctor communication, and enhancing knowledge of disease self-management through health information seeking. However, research shows racial and ethnic minorities are less likely than Whites to seek health information and use it in their physician visits. How racial and ethnic minorities use health information outside of their medical encounters is unknown. In this study we used data from the 2007 USA Health Tracking Household survey, a nationally-representative survey of civilian, non-institutionalized Americans (n = 12,549). Using logistic regression we found African Americans were no different from Whites in seeking health information and using it when they talked with their doctors. Latinos were significantly less likely than Whites to seek health information and less likely to use it when they talked with their doctors. But, among those who sought health information, African Americans and Latinos were significantly more likely than Whites to use health information to change their approach to maintaining their health and better understand how to treat illnesses. Also, education significantly moderated the relationship between race/ethnicity and health information seeking. However, results were mixed for education as a moderator in the relationship between race/ethnicity and health information use. Future research should focus on interventions to improve how African Americans and Latinos interface with providers and ensure that health information sought and used outside of their medical encounters augments treatment protocols.     

Preventive services for rural and urban African American adults

BACKGROUND: Studies have shown that African Americans and rural patients receive fewer preventive services than other patients. OBJECTIVE: To compare the use of preventive services by African Americans in urban and rural settings to determine if race and rural residence were additive risks for not obtaining preventive services. METHODS: Three hundred African American patients seeking care in family practices in South Carolina were surveyed about preventive health care. RESULTS: Rural and urban African Americans were equally likely to know about preventive services and be up-to-date on receiving these services. In both practices, those with lower incomes were less likely to be up-to-date. Patients seen in the urban setting were more likely to receive counseling regarding exercise and smoking than those in the rural practice (87% vs 71%, P = .003). CONCLUSIONS: For both urban and rural African American patients with access to primary care physicians, preventive service use is high. The best predictor of poor compliance with preventive service recommendations was low income, suggesting that a lack of access to care is the primary reason why rural and African American populations do not receive adequate preventive health care.     

An Outreach Intervention for Older Rural African Americans

This article describes the process, approaches, and selected outcomes of a rural care management outreach intervention for older African Americans in South Carolina. The model is a community-academic partnership between a federally qualified community health center, a rural health clinic, and the Medical University of South Carolina. Its aim is to improve access to and utilization of health care and social services to enhance the quality of life of older African Americans. This is being accomplished by using paid, trained outreach workers (called geriatric coordinators), who function as advocates in linking clients to needed health and social services through activities such as arranging transportation to health care, rescheduling missed medical appointments, providing health promotion, and making referrals to public benefits and indigent drug programs. Outcomes demonstrated that the use of geriatric coordinators as care managers is a feasible way of increasing quality of life for older African Americans. The most notable outcome showed that 54% of clients who were eligible but not receiving benefits prior to this intervention were signed on for programs such as Supplemental Security Income, Specified Low-Income Medicare Beneficiary (SLMB), Qualified Medicare Beneficiary (QMB), disability, railroad pensions, and Veterans Administration benefits. Health centers realized an increase in reimbursable services and new clients. Increased capacity for older adult services is being accomplished through geriatric-coordinator-directed collaborations with social service agencies and participation in community events and committees.     

Variation in Older Americans Act Caregiver Service Use,Unmet Hours of Care,and Independence Among Hispanics,African Americans,and Whites

Home- and community-based services (HCBS) are underused by minority seniors and their caregivers, despite greater rates of disability. We examined racial/ethnic variation among 1,749 Hispanics, African Americans, and Whites receiving Older Americans Act Title III caregiver services in 2009. In addition, we identified the volume of services used by caregivers, their unmet hours of respite care, and the relationship between service use and seniors' ability to live independently. Minority caregivers cared for seniors in urban areas who had higher rates of disability, poverty, and Medicaid coverage. Hispanics had the highest rate of unmet hours of care, while caregiver services were less likely to help African Americans remain at home. Minorities sought services through community agencies and were more educated than demographically similar national cohorts. Greater efforts to reach minority caregivers of less educated, disabled seniors in urban areas and through community agencies may reduce unmet needs and support independent living.     

Racial and Ethnic Discrimination,Medical Mistrust,and Satisfaction with Birth Control Services among Young Adult Latinas

Background

Racial/ethnic discrimination and medical mistrust contribute to disparities in use of and satisfaction with health care services. Previous work examining the influence of discrimination and medical mistrust on health care experiences has focused primarily on African Americans. Despite the finding that Latinas report lower rates of contraceptive use than White women, little is known about the influence of these factors on health care satisfaction, specifically satisfaction with contraceptive services, among Latina women.

Exploring racial influences on flu vaccine attitudes and behavior: Results of a national survey of White and African American adults

IntroductionRacial disparities in adult flu vaccination rates persist with African Americans falling below Whites in vaccine acceptance. Although the literature has examined traditional variables including barriers, access, attitudes, among others, there has been virtually no examination of the extent to which racial factors including racial consciousness, fairness, and discrimination may affect vaccine attitudes and behaviors.MethodsWe contracted with GfK to conduct an online, nationally representative survey with 819 African American and 838 White respondents. Measures included risk perception, trust, vaccine attitudes, hesitancy and confidence, novel measures on racial factors, and vaccine behavior.ResultsThere were significant racial differences in vaccine attitudes, risk perception, trust, hesitancy and confidence. For both groups, racial fairness had stronger direct effects on the vaccine-related variables with more positive coefficients associated with more positive vaccine attitudes. Racial consciousness in a health care setting emerged as a more powerful influence on attitudes and beliefs, particularly for African Americans, with higher scores on racial consciousness associated with lower trust in the vaccine and the vaccine process, higher perceived vaccine risk, less knowledge of flu vaccine, greater vaccine hesitancy, and less confidence in the flu vaccine. The effect of racial fairness on vaccine behavior was mediated by trust in the flu vaccine for African Americans only (i.e., higher racial fairness increased trust in the vaccine process and thus the probability of getting a flu vaccine). The effect of racial consciousness and discrimination for African Americans on vaccine uptake was mediated by perceived vaccine risk and flu vaccine knowledge.ConclusionsRacial factors can be a useful new tool for understanding and addressing attitudes toward the flu vaccine and actual vaccine behavior. These new concepts can facilitate more effective tailored and targeted vaccine communications.     

Stage at diagnosis and survival in a multiethnic cohort of prostate cancer patients

OBJECTIVES: We evaluated the effects of socioeconomic status and comorbidity on stage of disease and survival among 1509 population-based prostate cancer patients. METHODS: We applied logistic regression and Cox proportional hazards regression to data from Whites, African Americans, and Asian Americans who were diagnosed from 1987 to 1991. RESULTS: Patients with existing comorbid conditions were less likely than those without these conditions to be diagnosed with advanced cancer. Compared with Whites, African Americans (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.1, 2.2) and foreign-born Asian Americans (OR = 1.6; 95% CI = 1.0, 2.4) were more likely to be diagnosed with advanced cancer. Among men with localized disease, prostate cancer death rates were higher for African Americans than for Whites (death rate ratio = 2.3; 95% CI = 1.2, 4.7). CONCLUSIONS: These findings support the need for further investigation of factors that affect access to and use of health care among African Americans and Asian Americans.     

A Prescription for Internet Access: Appealing to Middle-Aged and Older Racial and Ethnic Minorities Through Social Network Sites to Combat Colorectal Cancer

The popularity and usage of social media networks or SNS (social networking sites) among American Internet users age 50 and over doubled between 2009 and 2010 and has steadily climbed. Part of this increased access may be the result of older adults who are living with a chronic disease and are reaching out for online support. Colorectal cancer (CRC) risk is among those concerns, particularly among middle-age and older minority populations where disparities exist. This exploratory study investigates information seeking behavior related to cancer factors (e.g. testing for colon cancer, cancer fatalism) and current social media usage among racial and ethnic minority groups (African American and Latinos) and Whites age 50 and older. The secondary data from the 2012 Health Information National Trends Survey (HINTS) was analyzed to compare these populations. Results show that African Americans and Latinos were only slightly more likely to use social network sites to seek out cancer information compared to Whites. However, Whites were more likely to use the Internet to seek health information compared to African Americans and Latinos. In this sample, Whites were also more likely to be informed by a physician about CRC testing (p <.01). Whites were also more fatalistic about CRC (p<.001) and more likely to have self-reported receiving a positive diagnosis (p <.001). Implications of this study suggest that use of both traditional health information sources (physician) and the Internet (social media networks, Internet sites) have increased among older Americans and can serve as critical channels for cancer information and education.     

Infant mortality differences between whites and African Americans: the effect of maternal education.

OBJECTIVES: Despite decreasing infant mortality in North Carolina, the gap between African Americans and Whites persists. This study examined how racial differences in infant mortality vary by maternal education. METHODS: Data came from Linked Birth and Infant Death files for 1988 through 1993. Multiple logistic regression models adjusted for confounders. RESULTS: Infant mortality risk ratios comparing African Americans and Whites increased with higher levels of maternal education. Education beyond high school reduced risk of infant mortality by 20% among Whites but had little effect among African Americans. CONCLUSIONS: Higher education magnifies racial differences in infant mortality on a multiplicative scale. Possible reasons include greater stress, fewer economic resources, and poorer quality of prenatal care among African Americans.     

Explaining persistent under-use of colonoscopic cancer screening in African Americans: A systematic review

IntroductionAlthough African Americans have the highest incidence and mortality from colorectal cancer (CRC), they are less likely than other racial groups to undergo CRC screening. Previous research has identified barriers to CRC screening among African Americans. However we lack a systematic review that synthesizes contributing factors and informs interventions to address persistent disparities.MethodsWe conducted a systematic review to evaluate barriers to colonoscopic CRC screening in African Americans. We developed a conceptual model to summarize the patient-, provider-, and system-level barriers and suggest strategies to address these barriers.ResultsNineteen studies met inclusion criteria. Patient barriers to colonoscopy included fear, poor knowledge of CRC risk, and low perceived benefit of colonoscopy. Provider-level factors included failure to recommend screening and knowledge deficits about guidelines and barriers to screening. System barriers included financial obstacles, lack of insurance and access to care, and intermittent primary care visits.ConclusionsThere are modifiable barriers to colonoscopic CRC screening among African Americans. Future interventions should confront patient fear, patient and physician knowledge about barriers, and access to healthcare services. As the Affordable Care Act aims to improve uptake of preventive services, focused interventions to increase CRC screening in African Americans are essential and timely.     

Racial and ethnic residential segregation and access to health care in rural areas

This study examined the relationship between racial/ethnic residential segregation and access to health care in rural areas. Data from the Medical Expenditure Panel Survey were merged with the American Community Survey and the Area Health Resources Files. Segregation was operationalized using the isolation index separately for African Americans and Hispanics. Multi-level logistic regression with random intercepts estimated four outcomes. In rural areas, segregation contributed to worse access to a usual source of health care but higher reports of health care needs being met among African Americans (Adjusted Odds Ratio [AOR]: 1.42, CI: 0.96-2.10) and Hispanics (AOR: 1.25, CI: 1.05-1.49). By broadening the spatial scale of segregation beyond urban areas, findings showed the complex interaction between social and spatial factors in rural areas.     

Professional service use among older African Americans,Black Caribbeans,and Non-Hispanic Whites for serious health and emotional problems

ABSTRACT

This study examined racial and ethnic differences in professional service use by older African Americans, Black Caribbeans, and Non-Hispanic Whites in response to a serious personal problem. The analytic sample (N = 862) was drawn from the National Survey of American Life. Findings indicated that African Americans and Black Caribbeans were less likely to use services than Whites. Type and race of providers seen varied by respondents’ race and ethnicity. Among respondents who did not seek professional help, reasons for not seeking help varied by ethnicity. Study findings are discussed in relation to practice implications.     

Racial differences in rural adults' attitudes toward issues of adolescent sexuality.

This study, based on a random sample of adults in a rural North Carolina county, demonstrates racial differences in rural adults' attitudes relating to adolescent sexual issues. Blacks were 50% more likely than Whites to indicate that public schools should provide general health care services, including pregnancy testing and treatment of sexually transmitted diseases, to teenagers; however, they were only half as likely as Whites to approve of sexual experimentation by adolescents. The local community's attitudes must be considered in the implementation of rural adolescent health programs, including acquired immunodeficiency syndrome education.     

The Role of Federally Funded Health Centers in Serving the Rural Population

CONTEXT: Federally funded health centers attempt to improve rural health by reducing and eliminating access barriers to primary care services. PURPOSE: This study compares rural health center patients with people in the general rural population for indicators of access to preventive services and health outcomes. METHODS: Data from the annual reporting system for federally funded health centers, the 1999 Uniform Data System, and published national census data were used to provide sociodemographic comparisons. Selected health status indicators, preventive services utilization, and health outcomes were obtained from a survey of health center patients, and the results were compared with the National Health Interview Survey and National Vital Statistics. FINDINGS: Unlike the nation's rural population, the majority of rural health center patients are of minority race/ethnicity, live at or below poverty, and are either uninsured or on Medicaid. Despite having higher prevalence of traditional access barriers than the general rural population, rural health center patients are significantly more likely to receive certain preventive services and also to experience lower rates of low birthweight, particularly for African American infants. However, rural health center patients are not more likely to have received influenza vaccination or up-to-date mammogram screening. CONCLUSIONS: Health centers provide access to essential preventive care for many of the most vulnerable rural residents. A national strategy to expand the rural health center network will likely help to ensure improved health for the considerable proportion of rural residents who still lack access to appropriate services.     

Racial and Ethnic Disparities in the Use of Mental Health Services

The authors used data from the 1998-1999 Community Tracking Study (CTS) household survey to examine variations in predictors of use of mental health services among different racial and ethnic groups (white, African American, Hispanic, and other). African Americans and Hispanics were less likely to have visited a mental health professional (MHP) in the prior year than were whites. Independent of health insurance and health status, low- to middle-income African Americans may be at particular risk for inadequate use of an MHP compared to higher-income African Americans. Similarly, upper-income Hispanics were more likely to have visited an MHP than Hispanics in the lowest income range. Adults aged 50 and older were less likely to visit an MHP than individuals aged 18-49. Depressed men were more likely to visit an MHP than depressed women. Efforts to reduce disparities should focus on lower-income racial and ethnic minorities.