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Minority/Rural Health

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Minority children receive fewer medications than white children

Compared with white children, black and Hispanic children are less likely to receive a prescribed medication for a specific condition and to receive fewer overall prescribed medications, even after accounting for other factors that affect the use of prescription medicines, such as health condition, number of physician visits, and socioeconomic status, according to Beth A. Hahn, Ph.D., a former research fellow with the Agency for Health Care Policy and Research. Drug therapy is required for many acute conditions in small children, and an estimated 40 percent of children's office visits are due to infectious diseases that require antibiotics or other prescription drugs.

Medicaid programs may need to specifically target the medication needs of minority children, suggests Dr. Hahn, who used data from the 1987 National Medical Expenditure Survey to examine the probability of receiving a prescription medication for children ages 1 to 5 years and 6 to 17 years. She found that among older children, just over half of minority children received a prescription medication compared with two-thirds of white children. And older white children received a higher average number of medications than either black or Hispanic children.

About 75 percent of younger white and Hispanic children received a prescription medication for a given condition compared with 63 percent of black children. There was no difference in the average number of medications prescribed for young Hispanic children compared with whites, but young black children on average received one less medication. Dr. Hahn's findings confirm those of other researchers who have demonstrated racial and ethnic differences in the receipt of health services and confirm that minority children receive fewer services than white children.

More details are in "Children's health: Racial and ethnic differences in the use of prescription medications," by Dr. Hahn, in the May 1995 issue of Pediatrics 95(5), pp. 727-732.

Racial variations found in use of community services by elderly rural residents

Although 85 percent of elderly North Carolinians are aware of community services such as home-delivered meals and senior centers, few use them. The most widely used services are senior centers (13 percent) and places that serve group meals (9 percent). Elderly blacks use both types of services to a larger extent than more economically advantaged whites, who may view these services as a "handout" and the centers as the domain of black people, explains Jim Mitchell, Ph.D., of East Carolina University, author of a study supported by the Agency for Health Care Policy and Research (HS05381).

Based on data from a 1990-1991 study of health care use among 868 noninstitutionalized elderly people in eastern North Carolina, Dr. Mitchell assessed the effects of demographics, need, and access to services on use of services such as help with chores, supplemental security income, home repair, meals on wheels, and home health care. Results showed that use of these services was most influenced by need (measured by chronic health conditions, number of prescription medications, and functional independence), regardless of access barriers such as illiteracy and lack of transportation.

Race was the only demographic variable that had a significant effect on senior center use. Elderly blacks with physical limitations and few social contacts, who had more help from others and were aware of the centers, were the most likely to use them. This suggests that senior centers are moving toward meeting the needs of elderly persons with limited capabilities rather than toward commonly perceived recreational or personal enrichment services, concludes Dr. Mitchell.

For more information, see "Service awareness and use among older North Carolinians," by Dr. Mitchell, in the June 1995 issue of The Journal of Applied Gerontology 14(2), pp. 193-209.

Rural Nebraskans have at least as much access to health care as their urban counterparts

Generally, access to health care is more limited in rural than urban America, according to several national surveys. Rural residents are more apt to be distant from doctors and hospitals, have limited public transportation, low income, and no health insurance compared with urban residents. Yet a new study shows that access to health care, even in isolated parts of rural Nebraska, was as good, if not better, than access to health care in urban parts of the State during the late 1980s. The fact that Nebraska's experience differs from the Nation as a whole argues for State involvement in developing any new networks for delivering health care services, note authors John Comer, Ph.D., and Keith Mueller, Ph.D., of the University of Nebraska Medical Center.

With support from the Agency for Health Care Policy and Research (HS05760), the researchers used a random sample of nearly 6,000 households to compare residents of urban and rural Nebraskan counties on several measures of access to health care. After controlling for health insurance status, they found that rural residents were more apt to have a personal physician and visit the physician more often than their urban counterparts. Even uninsured rural residents reported an average of two more visits than urban residents during the study year (1989-1990), even after accounting for need for health care (severity of illness). Also, a larger percentage of rural residents with health problems were hospitalized than urban residents, but this was a small and statistically insignificant difference.

Rural Nebraskans were no more likely to cite inability to pay as a deterrent to seeking care than urban Nebraskans. Nebraskan rural health care costs are cheaper than similar urban costs. Since the rural health care dollar goes a bit further, rural hospitals and physicians may be more willing to carry patients who cannot pay and who do not have insurance. This is not the kind of pattern one would expect if access were more of a problem in rural areas, conclude the researchers.

Details are in "Access to health care: Urban-rural comparisons from a midwestern agricultural state," by Dr. Comer and Dr. Mueller, in The Journal of Rural Health 11(2), pp. 128-136, 1995.

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