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AJPH
NEWS Release
EMBARGOED UNTIL September 29, 2003, 4:00 PM (ET)
CONTACT: For copies of articles, contact Natalie Raynor, (202)
777-2511, natalie.raynor{at}apha.org
All articles are online after the embargo date at www.ajph.org
American Journal of Public Health: October 2003 Highlights
The articles highlighted below appear in the October 2003 issue of the American Journal of Public Health, the Journal of the American Public Health Association.
____________________
HIV more deadly among minorities
In a study of about 5,700 HIV-positive veterans ages 25-84,
researchers found that minorities had poorer survival rates than
whites. In the study, an estimated 28 percent of the white patients
had a 90 percent to100 percent chance of being alive in five years,
compared with 22 percent of black patients and 14 percent of Hispanic
patients. And while the overall mortality rate of HIV-positive
veterans was 6.1 per 100 person-years, the mortality rate for
black veterans was 6.7, and for Hispanics in the study it was
7.1. One possible reasons that HIV was more deadly among minorities
was that higher proportions of black and Hispanic veterans had
four or more medical comorbidities such as heart disease and more
related HIV conditions than white veterans. Minority HIV patients
were diagnosed later in their illness and were generally sicker
at time of diagnosis than white HIV patients. "Interventions
need to be implemented to encourage minorities to seek regular
medical care, to persuade those at risk of HIV to be tested before
symptoms are advanced, and to alert providers of the importance
of HIV screening among minority patients with other chronic diseases,"
wrote the researchers, who urged more study into the issue.
[From: "Understanding Racial
Disparities in HIV: The Combined Use of Administrative Data and
a Clinical Cohort." Contact: Kathleen A. McGinnis, University
Center for Social and Urban Research, University of Pittsburgh,
kmcginnis{at}ucsur.pitt.edu.]
Latinos in managed care have poorer blood sugar than
whites in similar care settings
While managed care has in ways improved health care access
for many Latinos, one study of adults with diabetes in managed
care found that Latinos fared worse than whites when it came to
glycemic control and monitoring their own blood glucose levels.
The study looked at 2,941 white patients and 1,742 Latino patients
who responded to the Translating Research Into Action for Diabetes
Study. The study participants were enrolled in eight different
health plans. While those Latinos with diabetes in the study actually
reported better rates of foot self-care and blood-pressure control
than whites with diabetes, they did not do so well when it came
to self-monitoring of their blood glucose and maintaining healthy
blood glucose levels. Almost 50 percent of whites studied self-monitored
their blood glucose as recommended, while 38.5 percent of English-speaking
Latinos and 36.8 percent of Spanish-speaking Latinos reported
such monitoring. Latinos on insulin had blood glucose levels that
were up to 12 percent higher than comparable whites. The study's
authors estimate the disparity may be even more pronounced outside
managed care, where language barriers and lack of a regular health
care provider make control of chronic conditions even more of
a challenge.
[From: "Health Behaviors
and Quality of Care Among Latinos With Diabetes in Managed Care."
Contact: Arleen F. Brown, MD, PhD, David Geffen School of Medicine,
UCLA, abrown{at}mednet.ucla.edu.]
Some doctors less likely to recommend heart procedure
for black patients
When it comes to a procedure known in many cases to help
heart patients survive, black patients were far less likely to
receive the procedure than white patients if they were receiving
treatment at a public hospital. Researchers studied cardiac patients
at a Veterans Affairs hospital and a university hospital and found
that at the VA facility, doctors recommended cardiac revascularization
to 27 percent of black heart patients, compared to 50 percent
of white heart patients. There was no significant difference in
recommendations for the procedure for white and black patients
at the private hospital. "This study is important in that
it adds to a growing and needed literature examining reasons for
the marked and well-documented racial/ethnic disparities in use
of cardiac care and consequent outcomes," the study's authors
wrote. "The fact that one can observe racial/ethnic variations
in medical treatment decision making even in a system of equal
access such as the VA fuels the notion that there is perhaps disparity
in areas beyond access to care. Further in-depth studies are needed
to examine how physicians make decisions on cardiac care for patients
of varying cultural/ethnic backgrounds.
[From: "Racial/Ethnic Variations
in Physician Recommendations for Cardiac Revascularization."
Contact: Said A. Ibrahim, MD, MPH, Center for Health Equity Research
and Promotion, Pittsburgh VA Healthcare System, said.ibrahim2{at}med.va.gov.]
Data on patient race/ethnicity often inaccurate
As California voters prepare to vote on a ballot initiative
that would bar collection of race-based data and such data becomes
increasingly important in addressing health disparities among
minority populations, one study has found such data often is inaccurate.
In a study of Veterans Affairs administrative data pertaining
to more than 730,000 patients, researchers found that the racial/ethnic
data on file matched a person's self-reported race or ethnicity
only 60 percent of the time. The data were even less accurate
among racial and ethnic groups other than whites and blacks. One
reason: many patients belong to more than one racial/ethnic group
and might have been classified only once in their patient file.
Language barriers also posed a barrier to accurate data collection.
Those patients who were in the worst health and used the VA system
most often were more likely to have accurate racial data on file.
"Thus, results indicate that the more opportunities the VA
has to record race/ethnicity, the more likely its data are to
agree with patient self-reports."
[From: "Agreement Between
Administrative Data and Patients Self-Reports of Race/Ethnicity."
Contact: Nancy R. Kressin, PhD, Center for Health Quality, Outcomes
and Economic Research, A Medical Center, Bedford, MA, nkressin{at}bu.edu.]
Hispanics and Asians less satisfied with health care
than blacks and whites
Hispanic and Asian patients are less likely to have good rapport
with their doctors and also less likely to receive regular medical
care than whites and blacks, according to a recent study. In a
random telephone survey of 6,299 people, Asian and Hispanic respondents
reported the poorest overall quality of patient-physician interaction
and, the lowest levels of cultural sensitivity from their doctors.
They also were less likely to receive recommended preventive care
such as cancer screenings and checkups. "Further research
is needed to fully explicate the contribution of the patient-physician
relationship to disparities in health care," the study's
authors wrote. "In the meantime, efforts to improve cross-cultural
patient-physician interactions, including interventions to increase
patients' health literacy and physicians' interpersonal skills
and cultural sensitivity, should be undertaken. Without such efforts,
the goal of providing all Americans equitable access to health
care will be difficult to achieve."
[From: "Patient-Physician
Relationships and Racial Disparities in the Quality of Health
Care." Contact: Somnath Saha, MD, MPH, Portland VAMC, sahas@ohsu.edu.]
The American Journal of Public Health is the monthly journal of the American Public Health Association, the oldest and largest organization of public health professionals in the world. APHA is a leading publisher of public health-related books and periodicals promoting high scientific standards, action programs and policy for good health. More information is available at www.apha.org.
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