Minority Health: Recent Findings
- Improving Health Care for Minority Populations
- Cardiovascular Disease
- Care for the Elderly/Long-Term Care
- Chronic Illness
- Emergency Care/Hospitalization
- Health Care Access, Costs, and Insurance
- Mental/Behavioral Health
- Preventive Services
- Quality of Care/Patient Safety
- Reproductive Health and Birth Outcomes
- Additional Studies
- National Healthcare Quality and Disparities Reports
- For More Information
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The overall health of the American population has improved over the past few decades, but not all Americans have benefitted equally from these improvements. Minority populations, in particular, continue to lag behind whites in a number of areas, including quality of care, access to care, timeliness, and outcomes. Other health care problems that disproportionately affect minorities include provider biases, poor provider-patient communication, and health literacy issues.
Improvements in preventive services, care for chronic conditions, and access to care have led to a reduction and in some cases elimination of disparities in access to and receipt of care for some minority populations in areas such as receipt of mammography, timing of antibiotics, counseling for smoking cessation, and pediatric vision care. On the other hand, disparities in care continue to be a problem for some conditions and populations. For example, blacks, Asians, American Indians/Alaska Natives, and Hispanics continue to lag behind whites in the percentage of the population over 50 who receive colon cancer screening, and this gap has widened in recent years. Disparities also have increased for blacks and Hispanics, compared with whites, in the percentage of adults diagnosed with a major depressive disorder who received treatment for their depression in the 12 months following diagnosis.
The Agency for Healthcare Research and Quality supports extramural and intramural research on a broad range of topics related to health care quality and safety, effectiveness and outcomes, evidence-based medicine, health care delivery, and the costs and financing of health care. AHRQ also supports targeted research on health care for specific priority populations, including minorities. Additional resources and more detailed information can be found by visiting the AHRQ Web site at www.ahrq.gov.
This program brief summarizes findings from AHRQ-supported research on minority health reported in the literature and/or published by AHRQ from 2008 through mid-2012. Items marked with an asterisk (*) are available from AHRQ. Select for more information.
Researchers examine ways to increase breast cancer screening among Latinas.
This study evaluated two interventions to address the underuse of mammography and breast self-exam among Latinas: (1) participation in focus groups to assess knowledge about breast cancer and identify barriers to screening and (2) participation in discussion groups, including an animated video on breast self-exam plus training in the technique using latex models. Both interventions were cost effective and successful in increasing the women's knowledge and screening behaviors.
Source: Calderon, Bazargan, and Sangasubana, J Health Care Poor Underserved 21:76-90, 2010 (AHRQ grant HS14022).
Physicians often rely on untrained individuals to help them discuss breast cancer treatment with limited English-proficient women.
Researchers surveyed 348 physicians about their use and availability of trained interpreters when counseling limited English-proficient women with breast cancer. Nearly all of the physicians had treated patients with limited English proficiency in the preceding 12 months, and fewer than half reported good availability of trained medical interpreters or telephone language interpretation services. Instead, they used bilingual staff not specifically trained in medical interpretation and patients' family members or friends. This was particularly true for physicians in solo practice or single-specialty medical groups.
Source: Rose, Tisnado, Malin, et al., Health Serv Res 45(1):172-194, 2010 (Interagency agreement AHRQ/NCI).
Racial disparities seen in receipt of chemotherapy among older women with breast cancer.
The researchers examined 2002 data on 14,177 white women and 1,277 black women aged 65 and older who were diagnosed with operable stage II or IIIA breast cancer with positive lymph nodes. For the 65-69 age group, 66 percent of white women received chemotherapy within 6 months of diagnosis, compared with 56 percent of black women. This racial disparity diminished with advancing age; after age 74, there were no differences between white women and black women in receipt of chemotherapy.
Source: Bhargava and Du, Cancer 115(13):2999-3008, 2009 (AHRQ grant HS16743).
Geographic clustering of late-stage breast cancer cases can help target interventions to increase mammography use.
A telephone survey conducted between March 2004 and June 2006 in the St. Louis, MO area revealed that more black than white women had obtained mammograms during that time. St. Louis is an area known to have high rates of late-stage breast cancer diagnosis. The researchers suggest that such geographic clustering might be used to target specific populations and areas for interventions (e.g., traveling mammography vans, flexible clinic hours) that could increase mammography use.
Source: Lian, Jeffe, Schootman, J Urban Health 85(5):677-692, 2008 (AHRQ grant HS14095).
Less effective treatment and lower socioeconomic status may account for disparities in breast cancer survival.
Researchers studied more than 35,000 Medicare-insured women with early-stage breast cancer for as long as 11 years and found that black women were more likely than white women to live in the poorest census tract quartiles. Also, more black women (15.7 percent) received breast-conserving surgery without followup radiation therapy than white women (12.4 percent), Hispanic women (11 percent), and Asian women (7.9 percent). Since the recommended therapy for early-stage breast cancer is breast-conserving surgery plus radiation, these treatment differences could have contributed to disparities in survival, suggest the researchers.
Source: Du, Fang, and Meyer, Am J Clin Oncol 31(2):125-132, 2008 (AHRQ grant HS16743).
Tracking system greatly reduces racial disparities in receipt of adjuvant therapies among women with breast cancer.
These researchers developed a tracking system to follow women with breast cancer who had seen a surgeon so that they could be contacted in the event they did not connect with an oncologist. The researchers compared the treatment of 639 women who were seen at six New York City hospitals before implementation of the tracking system with 300 women who were seen while the tracking system was in use. Rates of oncology consultations, chemotherapy use, and hormonal therapy were higher for all women, particularly minority women, after the tracking system was in place. For example, underuse of radiotherapy declined from 23 to 10 percent, underuse of chemotherapy decreased from 26 to 6 percent, and underuse of hormone therapy decreased from 27 to 11 percent among black and Hispanic women.
Source: Bickell, Shastri, Fei, et al., J Natl Cancer Inst 100(23):1717-1723, 2008 (AHRQ grant HS10859).
Study finds disparities in receipt of chemotherapy following ovarian cancer surgery.
Clinical guidelines have recommended since 1994 that all women diagnosed with ovarian cancer stage IC-IV or higher receive chemotherapy following surgery to remove the cancer. This study of more than 4,000 black and white women aged 65 or older who were diagnosed with stage IC-IV ovarian cancer found that white women were more likely than black women to receive chemotherapy after surgery (65 percent vs. 50 percent, respectively), although survival rates did not differ between the two groups of women. Women with higher socioeconomic status (SES) had increased use of both surgery and chemotherapy, and women in the lowest quartile of SES were more likely to die than those in the highest quartile of SES.
Source: Du, Sun, Milam, et al., Int J Gynecol Cancer 18(4):660-669, 2008 (AHRQ grant HS16743).
Some Latinas have higher rates of cervical cancer than white women.
According to this study, women of Mexican descent born in the United States are at higher risk for contracting the human papillomavirus (HPV) that causes cervical cancer than white women and foreign-born Latinas. Indeed, those who have acculturated—i.e., they think, speak, and read English at home or with friends—are more likely than less acculturated Latinas to contract HPV and cervical cancer.
Source: Kepka, Coronado, Rodriguez, and Thompson, Prev Med 51(2):182-184, 2010 (AHRQ HS13853).
Several barriers to followup of an abnormal Pap smear may be encountered by Latinas.
In this study involving 40 Latinas who had an abnormal Pap smear, researchers identified four primary barriers to followup with colposcopy: anxiety or fear of the test, difficulty in scheduling the test around work and/or child care commitments, poor communication/language difficulties (30 women spoke Spanish only), and concern about pain.
Source: Percac-Lima, Aldrich, Gamba, et al., J Gen Intern Med 25(11):1198-1204, 2010 (AHRQ HS19161). See also National Healthcare Disparities Report 2008 (Intramural).
Elderly women, particularly black and Hispanic women, feel lifelong cervical cancer screening is important.
Researchers interviewed 199 women aged 65 or older about their preferences for cervical cancer screening. All of the women had received regular cervical cancer screenings, and none had undergone a hysterectomy. More than half of the women (58 percent) felt that lifelong screening was either important or very important. Compared with Asian and white women, Latinas and black women were more likely to hold strongly to this belief. Only 20 percent of women said they had talked with their physicians about ending screening.
Source: Sawaya, Iwaoka-Scott, Kim, et al., Am J Obstet Gynecol 200(1):40.el-40.e7, 2009 (AHRQ grant HS10856).
Lack of physician trust may partly explain black/white differences in prostate cancer mortality rates.
Prostate cancer mortality is more than twice as high for black men as for white men in the United States, and lack of physician trust may play a role in this disparity. More than 1,300 interviews were conducted with 474 men to examine the relationship between physician trust and health care access among black and white prostate cancer patients. Results showed that black men generally had lower levels of trust in their physicians than white men, particularly black men who reported having failed to seek medically necessary care.
Source: Do, Carpenter, Spain, et al., Cancer Causes Control 21:31-40, 2010 (AHRQ grant HS1085l).
Researchers find that blacks have higher rates of pituitary adenoma than other ethnic groups.
An analysis of 2004-2007 data covering nearly 26 percent of the U.S. population identified 8,276 cases of pituitary adenoma (tumors on the pituitary gland that are usually benign). The highest age-adjusted incidence of pituitary adenoma was found for blacks (4.4 cases per 100,000), and the lowest was found for American Indians/Alaska Natives (1.9 cases per 100,000). Blacks were more likely than other groups to have their pituitary adenomas diagnosed through x-ray alone (no microscopic confirmation), and even though their tumors were slightly larger than those found in whites, blacks had lower rates of surgical treatment than other groups.
Source: McDowell, Wallace, Carnahan, et al., Pituitary 14:23-30, 2011 (AHRQ grant HS16094).
Colorectal cancer survival rates vary by race.
According to this study, blacks have lower colorectal cancer survival rates than whites, Asians, and Hispanics. Asians have a lower risk of dying than whites, while mortality rates for Hispanics and whites are similar. The mortality differences between blacks and whites seen in this study were associated mostly with socioeconomic status (5 percent), tumor characteristics (3 percent), treatment (2 percent), and coexisting illness (2 percent). The researchers note that poor survival among blacks may also be related to biologic features that contribute to aggressive tumor behavior or to genetic abnormalities that may have an impact on response to therapy.
Source: White, Vernon, Franzini, and Du, Cancer 116:4622-4631, 2010. See also Du and Liu, J Health Care Poor Underserved 21:913-930, 2010; White, Liu, Xia, et al., Cancer 113(12):3400-3409, 2008 (AHRQ grant HS16743); Bazargan, Ani, Bazargan-Hejazi, et al., Patient Educ Counsel 76:240-247, 2009; and Ani, Bazargan, Bazargan-Hejazi, et al., Ethn Dis 18(2 Suppl 2):105-111, 2008 (AHRQ grant HS14022).
Blacks have higher lung cancer mortality rates than whites.
Lung cancer remains the leading cause of cancer-associated mortality, and blacks continue to have lower survival rates than whites. This study found that compared with whites, blacks with nonsmall-cell lung cancer (NSCLC) had a 22 percent greater overall risk of dying from all causes during the various stages of NSCLC, and blacks with stage III or IV NSCLC were 24 percent more likely to die from lung cancer than whites. Receipt of standard stage-specific treatment was significantly associated with longer survival, and poor socioeconomic status was associated with a greater risk of dying.
Source: Hardy, Xia, Liu, et al., Cancer 115(20):4807-4818, 2009. See also Hardy, Liu, Xia, et al., Cancer 115:2199-2211, 2009 (AHRQ grant HS16743).
More whites than blacks are diagnosed with non-Hodgkin lymphoma, but blacks are more likely to die from it.
An estimated 63,000 elderly individuals are diagnosed with non-Hodgkin lymphoma (NHL) in the United States each year. Whites are more likely than other groups to be struck with the disease, but compared with blacks, they also are more likely to receive life-prolonging chemotherapy. In this study, blacks were significantly less likely than whites to receive chemotherapy (43.2 vs. 52.4 percent). Also, lower socioeconomic status, more common among the black patients studied, was significantly associated with a higher risk of dying.
Source: Wang, Burau, Fang, et al., Cancer 113(11):3231-3241, 2008 (AHRQ grant HS16743).
Among American Indians, perceived cancer risk is associated with self-reported family history of cancer.
A random survey of 182 American Indian adults living on a Hopi reservation in Northeastern Arizona found that knowledge of cancer risk factors and attitudes about cancer prevention were not associated with the participants' perceived risk of cancer. Only a family history of cancer was significantly associated with perceived risk in this population.
Source: Gonzales, Ton, Garroutte, et al., Ethn Dis 20:458-462, 2010 (AHRQ grant HS10854).
Men and blacks often are not aware of cancer screening benefits.
Characteristics like sex, race, and education level are associated with how well patients understand the benefits of cancer screening. For this study, researchers surveyed a diverse group of 467 women and 257 men aged 50 and older from seven primary care practices in North Carolina to elicit their feelings about various cancer screening tests. About half of those surveyed were unsure of what to do about cancer screening, although most knew about its benefits. Men were only about half as likely as women to know the benefits of cancer screening, and blacks were much more likely than whites not to know about the benefits.
Source: Gourlay, Lewis, Preisser, et al., Fam Med 42(6):421-427, 2010 (AHRQ grant HS13521). See also Carpenter, Howard, Taylor, et al., Cancer Causes Control 21:1071-1080, 2010 (AHRQ grant HS13353) and Pagan, Su, Li, et al., Am J Prevent Med 37(6):524-530, 2009 (AHRQ grant HS17003).
Racial disparities in access to specialized cancer care vary by place of residence.
Using 2000 census data, researchers calculated the travel times to specialized cancer centers and oncologists for all ZIP code areas and found that rural blacks have the longest travel times to National Cancer Institute centers of care. Rural blacks were only 42 percent as likely as rural whites to seek care at these national centers.
Source: Onega, Duell, Shi, et al., J Rural Health 26:12-19, 2010. See also Onega, Duell, Shi, et al., Cancer 112(4):909-918, 2008 (AHRQ grant T32 HS00070); and Outcomes of Community Health Worker Interventions, Evidence Report/Technology Assessment No. 181.
Among people with melanoma, neighborhood socioeconomic factors affect prognosis.
According to this study, melanoma prognosis is significantly associated with neighborhood racial heterogeneity, education, and income. Patients who live in predominantly white, wealthy, and highly educated communities are less likely to have a poor prognosis compared with those living in less advantaged communities.
Source: Eide, Weinstock, and Clark, J Health Care Poor Underserved 20:227-245, 2009 (AHRQ grant T32 HS00011).
Race influences participation of companions in cancer consultations.
Companions can play an important role in meetings between newly diagnosed cancer patients and their clinicians. For this study involving newly diagnosed lung cancer patients researchers recorded and analyzed conversations between clinicians from a medical center’s oncology or thoracic surgery clinic and the patients and their companions (if applicable). They found that the companions of black patients were less active participants in the conversation compared with the companions of white patients. Companions were more likely to be active participants when the physician’s communication emphasized partnership-building and supportive talk and when the lung cancer diagnosis had been made before the visit.
Source: Street and Gordon, Psychooncology 17:244-251, 2008 (AHRQ grant HS10876).
Blacks who receive heart transplants have poorer survival than patients of other races.
Researchers analyzed outcomes data for nearly 40,000 patients who underwent heart transplants over a 22-year period (1987-2009). Almost 5,000 of the patients were black, and they had a 34 percent higher risk of transplant-related death than the nearly 31,000 white patients. Transplant recipients of other races (2,118 Hispanics, 967 Asians, and patients from other non-black groups) did not differ from whites in adjusted risk of transplant-related death.
Source: Liu, Bhattacharaya, Weill, et al., Circulation 123(15):1642-1649 (AHRQ grant HS19181).
Racial disparities found in the use of statins and/or aspirin to prevent cardiovascular disease.
According to this study involving adults at high risk of cardiovascular disease (CVD), blacks are less likely than whites to use statins (38 percent vs. 50 percent, respectively) or aspirin (29 percent vs. 44 percent) to prevent CVD. The researchers note that these disparities in the use of CVD medications may contribute to the documented disparities between blacks and whites in CVD outcomes. Statin use did not differ between whites and Hispanics, but Hispanics were less likely than whites to use aspirin.
Source: Qato, Lindau, Conti, et al., Pharmacoepidemiol Drug Saf 19:834-842, 2010 (AHRQ grant HS13599).
Increasing access to coronary angiography led to a reduction in racial disparities in New Jersey.
Researchers examined the effects of regulatory reforms in New Jersey between 1996 and 2003 and found that a doubling of angiography facilities closed the gap between blacks and whites in access to these services. Reducing this disparity was significant, since blacks are at higher risk for heart disease and have higher cardiac death rates than whites, note the researchers.
Source: Cantor, Delia, Tiedemann, et al., Health Aff 28(5):1521-1531, 2009 (AHRQ grant HS14191).
Disparities persist in access to specialists for patients with cardiovascular disease.
Researchers examined medical records for 9,761 adults with coronary artery disease (CAD) or congestive heart failure (CHF) at primary care practices affiliated with two academic medical centers from 2000 to 2005. They found that 79.6 percent of patients with CAD and 90.3 percent of patients with CHF had a cardiology consultation during that period. Men were more likely than women to be referred to a cardiologist, and patients being treated at community health centers were less likely than those at hospital-based practices to receive a consultation. Blacks were more likely than whites to obtain an initial consultation, but those with CHF had fewer followup consultations than whites, which may reflect weaker relationships with their specialists, note the researchers.
Source: Cook, Ayanian, Orav, and Hicks, Circulation 119:2463-2470, 2009 (AHRQ grant T32 HS00020).
Better short-term survival of blacks with heart failure correlates with less severe illness at hospital admission.
Researchers analyzed data on 1,408 blacks and 7,260 whites who were admitted to the hospital from the emergency department (ED) during 2003 and 2004 and discharged with a diagnosis of heart failure. Overall, black patients were younger than white patients (65.8 years vs. 77.4 years) and were much more likely than white patients to be assigned to the lowest risk class using one of three prediction rules. Two possible explanations for these findings are: (1) blacks are less likely than whites to have a usual source of care and may be more likely to seek initial care for heart failure in the ED; and (2) better access to primary care for whites may paradoxically result in greater illness severity when they do arrive at the ED, since they are more likely to visit the ED after failure of initial outpatient treatment.
Source: Auble, Hsieh, and Yealy, Am Heart J 157(2):306-311, 2009 (AHRQ grant HS10888).
Nurse-led disease management for heart failure is cost effective in ethnically diverse urban areas.
Researchers randomized 406 low-income patients with heart failure to either usual care or a nurse-led disease management program. All of the patients were from the Harlem neighborhood of New York City, and most were black or Hispanic. During the year-long program, patients in the intervention group received regular telephone calls and dietary instruction. Compared with patients in the usual care group, the nurse-led patients maintained better physical functioning and had higher quality-of-life scores. The per-patient cost of the nurse-led intervention was $2,177, which was offset by the $2,378 in lower hospitalization costs per person.
Source: Hebert, Sisk, Wang, et al., Ann Intern Med 149:540-548, 2008 (AHRQ grant HSI0402).
Female and black stroke patients are less likely to receive preventive care to avoid further strokes.
One in three stroke survivors will suffer another stroke within 5 years, but there are measures clinicians can take to reduce the risk of another stroke. According to this study of 501 patients hospitalized for acute ischemic stroke, 54 percent of whites, 62 percent of Hispanics, and 77 percent of blacks received incomplete inpatient evaluations. Similarly, 66 percent of women had incomplete inpatient evaluations, compared with 54 percent of men. In addition, 40 percent of whites, 43 percent of Hispanics, and 59 percent of blacks received inadequate discharge regimens of anticoagulant, antihypertensive, and lipid-lowering medications. Blacks and Hispanics are at greater risk for recurrent strokes than whites. Improving delivery of these effective interventions will reduce recurrent stroke risk and may reduce stroke risk disparities among minorities, conclude the researchers.
Source: Tuhrim, Cooperman, Rojas, et al., J Stroke Cerebrovasc Dis 17(4):226-234, 2008 (AHRQ grant HS10859).
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