|2004 Abstracts, presentation slides, and handouts|
Is Health Care Entitlement a Solution to the Problem of Health Disparities for American Indians/Alaska Natives?
The evidence for various racial and ethnic health disparities continues to grow while promising innovative solutions to eliminate these disparities continue to be defined. While the progress toward implementing these solutions is slow, there appears to be consensus that any sustainable solution to eliminating health disparities requires building alliances and strengthening partnerships with the racial and ethnic communities experiencing these problems.
The need to improve the health status of American Indians/Alaska Natives has been a longstanding goal pursued by tribal communities, their advocates, and the federal Indian Health Service. One objective to achieve this goal has involved the realization of self-determination, a policy change that has encouraged tribes to take over management of their own health care delivery systems. Unlike other minority populations in the United States, American Indians and Alaska Natives have a unique government-to-government relationship with the federal government, an arrangement that often serves as the only mechanism to bring about policy change and/or to bring additional resources to help create change. At the present, tribes are supporting the reauthorization of key health legislation that includes a provision to initiate a study to examine health care entitlement. It is against this backdrop that this presentation will discuss the key health disparities faced by American Indians/Alaska Natives, the funding of health care, and the congressional route advocated for resolving some of these health disparities.
Neighborhoods and Health Disparities
The goal of this presentation is to provide a framework for understanding how neighborhoods may explain ethnic disparities in health. We begin with a brief overview of the patterns of residence and settlement by ethnicity, including a discussion of the major concepts related to these patterns (segregation, ethnic enclaves) and the processes that may have led to their development (e.g. institutionalized racism). We then examine the relationship between residence and health, focusing in particular on the neighborhood processes that may lead to differential outcomes by ethnicity. In particular, we will focus on neighborhood resources, community stressors, and environmental justice. Finally, we will consider the extent to community redevelopment provides a potential avenue to shape the health of all communities and a way to eliminate health disparities.
Judith C. Bradford, MA, PhD
Foundations for Sexual Minority Health
The health of sexual minority individuals and communities became a concern for public health in the United States when "persons defined by sexual orientation" were included in Healthy People 2010 as one of six groups experiencing health disparities and barriers to healthcare access. LGBT professional organizations and researchers worked with local, state, and federal government representatives to develop a common understanding of the health concerns and needs of sexual minorities, resulting in the initiation of the emerging field of lesbian, gay, bisexual, and transgender (LGBT) health. Remarkable progress has been made during the past five years to establish a unifying conceptual framework for this work and to develop an organizational infrastructure to address the multi-level challenges that must be overcome in order sexual minorities to have access to quality healthcare. The purpose of this presentation is to provide a framework for tackling several big questions: who are sexual minority persons and what are their healthcare needs? what factors influence the health of sexual minorities? how can public health respond? how do we set priorities, and what are the most important opportunities and challenges?
Ana Abraido-Lanza, PhD
The Latino mortality paradox revisited: Is Acculturation Bad for Your Health?
There is a great body of evidence on the inverse relationship between socioeconomic status and morbidity and mortality. Relative to non- Latino whites, Latinos in the United States have a worse socioeconomic status profile, but a lower all-cause mortality rate. This paradox has stimulated various hypotheses, such as selective migration of healthier individuals. This presentation will provide a general overview of hypotheses proposed to explain the Latino mortality paradox, as well as research findings concerning the paradox. Particular emphasis will be placed on the health behaviors and acculturation hypotheses, which posit that: (1) Latinos have more favorable health behaviors and risk factor profiles than non-Latino whites, and (2) Health behaviors and risk factors become more unfavorable with greater acculturation. An overview of concepts and theories on acculturation and health will be provided. Research findings will be highlighted from studies that test theoretical models concerning the association between acculturation and various health behaviors (e.g., breast cancer screening).
Jerome Wilson, MA, PhD
Racial Disparities in Prescription Drug Utilization: An Analysis of Beta-Blocker and Statin Use Following Hospitalization for Acute Myocardial Infarction
OBJECTIVE: To assess the whether the use of beta-blockers and statins following hospitalization for an acute myocardial infarction (MI) varies by race/ethnicity among Medicaid recipients.
METHODS: This retrospective study used administrative claims and eligibility information from a 20% random sample of California Medicaid recipients. We selected adult patients who were hospitalized for acute MI between January 1, 1998 and December 31, 2000. Study patients were required to be eligible for medical and pharmacy benefits for six months prior to their MI to three months following the event. Patients were excluded if they did not have a known race/ethnicity (i.e., white, African American, Hispanic, Asian) recorded. Medical claims were used to assess the burden of comorbidity in the six months prior to hospitalization. Pharmaceutical claims were used to identify beta-blocker and statin drugs dispensed following the MI hospitalization. Logistic regression was used to assess the relation between race/ethnicity and the likelihood of use of beta-blockers and statins, respectively, adjusting for other potential differences in patient characteristics and comorbidity.
RESULTS: We identified 2,069 patients who were hospitalized for MI who met the cohort inclusion criteria. They had a mean age of 71 years and 54% were female. Fifty-eight percent were white, 23% were Asian, 14% were African American, and 5% were Hispanic. The average Charlson comorbidity score (excluding MI) was 1.8 (±1.3). Approximately one-half of patients were dispensed beta-blockers and one-third received statins in the 90 days following hospitalization. Compared with whites, African-American patients were significantly less likely to receive either beta-blockers (adjusted odds ratio 0.71; 95% CI 0.55 to 0.93) or statin therapy (OR: 0.66; 0.49 to 0.88), and hispanics were less likely to be dispensed statins (OR: 0.52; 0.32 to 0.85). Asian patients did not differ from whites in the likelihood of receiving either type of therapy.
CONCLUSIONS: In this Medicaid population, a relatively low proportion of patients were dispensed beta-blocker or statin drugs following an MI hospitalization. African-Americans, and to a lesser extent, Hispanics, were the least likely to receive treatment.
|Last updated May 04, 2012|