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Ethnic Disparities (ethnic + disparity)
Selected AbstractsRacial and Ethnic Disparities in Health: An Emergency Medicine PerspectiveACADEMIC EMERGENCY MEDICINE, Issue 11 2003Janice C. Blanchard MD Abstract Significant disparities exist in health care based on race. Even when controlling for socioeconomic factors, minorities still have lower rates of utilization for certain procedures, higher mortality rates, and differences in usual source of care. There are a multitude of causes for these disparities, including differences based on access to care, the patient,doctor relationship, and insurance status. This article addresses possible factors that account for persistent disparities in health based on race and suggests approaches to remedying these disparities. Although many studies have been done on this topic, further research is needed to examine factors specifically in the emergency department setting. [source] Addressing Racial and Ethnic Disparities in Health Care: Using Federal Data to Support Local Programs to Eliminate DisparitiesHEALTH SERVICES RESEARCH, Issue 4p1 2006Thomas D. Sequist To reduce racial and ethnic disparities in health care, managers, policy makers, and researchers need valid and reliable data on the race and ethnicity of individuals and populations. The federal government is one of the most important sources of such data. In this paper we review the strengths and weaknesses of federal data that pertain to racial and ethnic disparities in health care. We describe recent developments that are likely to influence how these data can be used in the future and discuss how local programs could make use of these data. [source] Strengthening the Health Services Research to Reduce Racial and Ethnic Disparities in Health careHEALTH SERVICES RESEARCH, Issue 5 2003Carolyn M. Clancy First page of article [source] Overcoming Racial and Ethnic Disparities in Blood Pressure Control: A Patient-Centered Approach to Cross-Cultural CommunicationJOURNAL OF CLINICAL HYPERTENSION, Issue 8 2008Michael J. Bloch MD "It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.",William Osler1 [source] Racial/Ethnic Disparities in Knowledge about Risks and Benefits of Breast Cancer Treatment: Does It Matter Where You Go?HEALTH SERVICES RESEARCH, Issue 4 2008Sarah T. Hawley Objective. To evaluate the association between provider characteristics and treatment location and racial/ethnic minority patients' knowledge of breast cancer treatment risks and benefits. Data Sources/Data Collection. Survey responses and clinical data from breast cancer patients of Detroit and Los Angeles SEER registries were merged with surgeon survey responses (N=1,132 patients, 277 surgeons). Study Design. Cross-sectional survey. Multivariable regression was used to identify associations between patient, surgeon, and treatment setting factors and accurate knowledge of the survival benefit and recurrence risk related to mastectomy and breast conserving surgery with radiation. Principal Findings. Half (51 percent) of respondents had survival knowledge, while close to half (47.6 percent) were uncertain regarding recurrence knowledge. Minority patients and those with lower education were less likely to have adequate survival knowledge and more likely to be uncertain regarding recurrence risk than their counterparts (p<.001). Neither surgeon characteristics nor treatment location attenuated racial/ethnic knowledge disparities. Patient,physician communication was significantly (p<.001) associated with both types of knowledge, but did not influence racial/ethnic differences in knowledge. Conclusions. Interventions to improve patient understanding of the benefits and risks of breast cancer treatments are needed across surgeons and treatment setting, particularly for racial/ethnic minority women with breast cancer. [source] Race and Ethnicity in Access to and Outcomes of Liver Transplantation: A Critical Literature ReviewAMERICAN JOURNAL OF TRANSPLANTATION, Issue 12 2009A. K. Mathur Racial/ethnic disparities in access to and outcomes of liver transplantation are an important topic given the increasing diversity in the United States. Most reports on this topic predate the advent of allocation based on the model for end-stage liver disease (MELD). For many patients with a variety of lethal conditions, liver transplantation is the only effective therapy, signifying the importance of equitable access to care. Racial/ethnic disparities have been described at various steps of the liver transplant process, including liver disease prevalence and treatment, access to a transplant center and its waitlist, receipt of a liver transplant and posttransplant outcomes. The purpose of this minireview is to critically evaluate the published literature on racial/ethnicity-based disparities in liver disease prevalence and treatment, transplant center referral, transplant rates and posttransplant outcomes. We identify the shortcomings of previous reports and detail the barriers to completing properly constructed analyses, particularly emphasizing deficits in requisite data and the need for improved study design. Understanding the nature of race/ethnicity-based disparities in liver transplantation is necessary to improve research initiatives, policy design and serves the broader responsibility of providing the highest quality care to all patients with liver disease. [source] PUNISHING THE "MODEL MINORITY": ASIAN-AMERICAN CRIMINAL SENTENCING OUTCOMES IN FEDERAL DISTRICT COURTS,CRIMINOLOGY, Issue 4 2009BRIAN D. JOHNSON Research on racial and ethnic disparities in criminal punishment is expansive but remains focused almost exclusively on the treatment of black and Hispanic offenders. The current study extends contemporary research on the racial patterning of punishments by incorporating Asian-American offenders. Using data from the United States Sentencing Commission (USSC) for FY1997,FY2000, we examine sentencing disparities in federal district courts for several outcomes. The results of this study indicate that Asian Americans are punished more similarly to white offenders compared with black and Hispanic offenders. These findings raise questions for traditional racial conflict perspectives and lend support to more recent theoretical perspectives grounded in attribution processes of the courtroom workgroup. The article concludes with a discussion of future directions for research on understudied racial and ethnic minority groups. [source] Addressing Racial and Ethnic Disparities in Health Care: Using Federal Data to Support Local Programs to Eliminate DisparitiesHEALTH SERVICES RESEARCH, Issue 4p1 2006Thomas D. Sequist To reduce racial and ethnic disparities in health care, managers, policy makers, and researchers need valid and reliable data on the race and ethnicity of individuals and populations. The federal government is one of the most important sources of such data. In this paper we review the strengths and weaknesses of federal data that pertain to racial and ethnic disparities in health care. We describe recent developments that are likely to influence how these data can be used in the future and discuss how local programs could make use of these data. [source] An overview of ethnicity and assessment of family history in primary care settingsJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 10 2006Ann Maradiegue PhD(c), FNP-C (Instructor, Family Nurse Practitioner Program) Abstract Purpose: To discuss the importance of and the nurse practitioner's (NP's) role in the assessment of ethnicity/family of origin in conducting a multigenerational family history in primary care settings. Data sources: A review of the literature on past research results addressing racial and ethnic disparities and current articles from scientific journals exploring the relationship between race and genetics. Web sites were from the National Institutes of Health, the Human Genome Research Institute, the National Cancer Institute, and the Health and Human Services Minority Health and Disparities report. Conclusions: The family history has received renewed interest due to the sequencing of the human genome. A multigenerational family history is an important first step in screening for a multitude of disorders impacted by genetic susceptibility, shared environments, and common behaviors. Assessment of the patient's ethnicity/family of origin is an integral part of the multigenerational family history, particularly in the diagnosis of chronic diseases and the assessment of risks for genetic disorders. The multigenerational family history is important in diagnosis, predictive genetic testing, disease prevention, and health promotion. Challenges facing NPs and the utilization of a multigenerational family history in the current U.S. health system include (a) training clinicians on the correct assessment and utilization of a multigenerational family history, (b) assessment of the subtleties of ethnicity and identifying multiple ethnic groups within a family, (c) collection of the family history in a manner that is sensitive to the cultural beliefs of individuals, and (d) avoidance of stereotyping Implications for practice: Significant advances in genetics and genetic testing requires that NPs be well versed in collecting and interpreting a multigenerational family history to include assessment of the patient/family's ethnicity/family of origin. The ability to effectively conduct and evaluate the individual's and family's health risk through a multigenerational family history will be important in diagnosis, health promotion, disease prevention, and the determination for genetic counseling referral and predictive testing when appropriate. Assessment of risk and prevention of disease is also important in reducing health disparities. [source] Quality of Care and Racial Health Disparities: A Strategic OverviewMOUNT SINAI JOURNAL OF MEDICINE: A JOURNAL OF PERSONALIZED AND TRANSLATIONAL MEDICINE, Issue 1 2008Mark R. Chassin MD Substantial racial and ethnic disparities in health and health care exist in the United States. The Department of Health Policy at the Mount Sinai School of Medicine has developed a strategy for reducing those disparities that builds upon its quality improvement experience. This article discusses the utility of applying quality improvement principles to the development of interventions to eliminate underuse of effective treatments and reduce the disparities that may arise from this quality problem. We present a conceptual model of racial disparities in health and our underuse hypothesis. Parallels between our disparities research strategy and six sigma quality improvement methods are described. Finally, the article provides an example of how we have been able to successfully implement proven-effective health improvement programs in the Harlem community even after grant funding has ended. Mt Sinai J Med 75:7,12, 2008. © 2008 Mount Sinai School of Medicine [source] The Unequal Burden of Pain: Confronting Racial and Ethnic Disparities in PainPAIN MEDICINE, Issue 3 2003Carmen R. Green MD ABSTRACT context. Pain has significant socioeconomic, health, and quality-of-life implications. Racial- and ethnic-based differences in the pain care experience have been described. Racial and ethnic minorities tend to be undertreated for pain when compared with non-Hispanic Whites. objectives. To provide health care providers, researchers, health care policy analysts, government officials, patients, and the general public with pertinent evidence regarding differences in pain perception, assessment, and treatment for racial and ethnic minorities. Evidence is provided for racial- and ethnic-based differences in pain care across different types of pain (i.e., experimental pain, acute postoperative pain, cancer pain, chronic non-malignant pain) and settings (i.e., emergency department). Pertinent literature on patient, health care provider, and health care system factors that contribute to racial and ethnic disparities in pain treatment are provided. evidence. A selective literature review was performed by experts in pain. The experts developed abstracts with relevant citations on racial and ethnic disparities within their specific areas of expertise. Scientific evidence was given precedence over anecdotal experience. The abstracts were compiled for this manuscript. The draft manuscript was made available to the experts for comment and review prior to submission for publication. conclusions. Consistent with the Institute of Medicine's report on health care disparities, racial and ethnic disparities in pain perception, assessment, and treatment were found in all settings (i.e., postoperative, emergency room) and across all types of pain (i.e., acute, cancer, chronic nonmalignant, and experimental). The literature suggests that the sources of pain disparities among racial and ethnic minorities are complex, involving patient (e.g., patient/health care provider communication, attitudes), health care provider (e.g., decision making), and health care system (e.g., access to pain medication) factors. There is a need for improved training for health care providers and educational interventions for patients. A comprehensive pain research agenda is necessary to address pain disparities among racial and ethnic minorities. [source] Ethnic differences in anemia among patients with diabetes mellitus: The Diabetes Study of Northern California (DISTANCE),AMERICAN JOURNAL OF HEMATOLOGY, Issue 1 2010Ameena T. Ahmed To examine ethnic differences in hemoglobin testing practices and to test the hypothesis that ethnicity is an independent predictor of anemia among patients with diabetes mellitus. We conducted a panel study to assess the rate of hemoglobin testing during 1999,2001 and the period prevalence and incidence of anemia among 79,985 adults with diabetes mellitus receiving care within Kaiser Permanente of Northern California. Anemia was defined as hemoglobin <13.0 g/dL in men or < 12.0 g/dL in women. Overall, 82.1% of the cohort was tested for anemia at least once during the 3-year study period. Mixed ethnicity patients were most likely to be tested, followed by whites, blacks, Latinos, and Asians (P < 0.0001). Fifteen percent of the cohort had prevalent anemia at baseline, and an additional 22% of those tested developed anemia during the study period. Anemia was more prevalent among blacks and mixed ethnicity persons compared with other racial/ethnic groups. Anemia was also more prevalent among those ,70 years of age or with estimated glomerular filtration rate <60 ml/min/1.73 m2. In multivariable models, blacks had higher and Asians had lower odds of prevalent anemia and hazard ratios of incident anemia compared with whites. Within a large, diverse cohort with diabetes, ethnicity was predictive of anemia, even after adjustment for age, level of kidney function, and other potential confounders. Blacks with diabetes are at increased risk of anemia relative to whites. These differences may account for some of the observed ethnic disparities in diabetes complications. Am. J. Hematol., 2010. © 2009 Wiley-Liss, Inc. [source] Racial and ethnic disparities in work-related injuries and socio-economic resources among nursing assistants employed in US nursing homes,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 10 2010SangWoo Tak ScD Abstract Background We aimed to estimate the proportion of nursing assistants (NAs) in the US with work-related injuries and insufficient socio-economic resources by race/ethnicity. Methods Data from the 2004 National Nursing Assistant Survey (NNAS), a nationally representative sample survey of NAs employed in United States nursing homes, were analyzed accounting for the complex survey design. Results Among 2,880 participants, 44% reported "scratch, open wounds, or cuts" followed by "back injuries" (17%), "black eyes or other types of bruising" (16%), and "human bites" (12%). When compared to non-Hispanic white NAs, the adjusted rate ratio (RR) for wound/cut was 0.74 for non-Hispanic black NAs (95% confidence interval [CI]: 0.65,0.85). RRs for black eyes/bruises were 0.18 for non-Hispanic black NAs (95% CI: 0.12,0.26), and 0.55 for Hispanic NAs (95% CI: 0.37,0.82). Conclusions Minority racial and ethnic groups were less likely to report having experienced injuries compared with non-Hispanic white NAs. Future research should focus on identifying preventable risk factors, such as differences by race and ethnicity in the nature of NA jobs and the extent of their engagement in assisting patients with activities of daily living. Am. J. Ind. Med. 53:951,959, 2010. © 2010 Wiley-Liss, Inc. [source] Racial and ethnic disparities in low birth weight delivery associated with maternal occupational characteristicsAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 2 2010John D. Meyer MD Abstract Objectives Work characteristics and maternal education have both been associated with low birth weight (LBW) delivery. We sought to examine the relative contribution of these two factors to LBW delivery and determine whether ethnic/racial differentials in educational attainment and work characteristics might play a role in well-described disparities in LBW. Methods Scores for work substantive complexity (SC) derived from the O*NET were imputed to maternal occupation for Connecticut singleton births in 2000. Risks for LBW were estimated separately for black, Hispanic, and white mothers using logistic regression controlling for maternal covariates. Results Using white mothers as a referent, working is associated with reduced LBW risk in black mothers compared to those not in work (OR 2.06 vs. 3.07). LBW in working black women was strongly associated with less that a high school education (OR 4.80, 95% CI 1.68,13.7), and with low work SC in blacks in those with a college education or greater (OR 4.48, 95% CI 1.24,16.2). Examination of work SC scores, controlling for age and educational level, showed lower values for blacks; increased work SC was seen in Hispanics after adjustment for lower educational attainment. A decrease in risk for LBW was seen in black mothers, compared with whites, as work SC increased. By contrast, college-educated black mothers had a greater risk for LBW than those with high school or some college education. Conclusions Maternal employment and work in a job with greater SC were associated with a reduced risk of LBW in black mothers. Improved LBW risk was also seen with employment in Hispanics. Low work SC in those with higher educational attainment was strongly associated with LBW in blacks, but not whites or Hispanics. Education/work mismatch may play a role in racial disparities in birth outcomes. Am. J. Ind. Med. 53:153,162 2010. © 2009 Wiley-Liss, Inc. [source] Joint replacement surgeries among medicare beneficiaries in rural compared with urban areasARTHRITIS & RHEUMATISM, Issue 12 2009Mark L. Francis Objective People in rural areas live farther away from hospitals than do people in urban areas. Thus, there is concern that people living in rural areas may be less willing or able to undergo elective surgical procedures. This study was undertaken to determine whether Medicare beneficiaries in rural areas were less likely to have elective total knee or hip replacement surgeries compared with their urban counterparts. Methods We performed a cross-sectional study of Medicare beneficiaries, controlling for age, sex, race/ethnicity, and economic status. Beneficiaries were assigned to rural versus urban areas based on their zip code of residence and the 10-point Rural-Urban Commuting Area designation. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. Results Compared with urban beneficiaries, rural beneficiaries were 27% more likely to have total knee or hip replacement surgeries (OR 1.27 [95% CI 1.26,1.28]). After adjusting for age, sex, race/ethnicity, median household income, average house value, mean poverty ratio, and state of residence, rural beneficiaries were still 14% more likely to have total joint replacement surgeries (OR 1.14 [95% CI 1.13,1.16]). Differential use of surgery before and after receiving Medicare eligibility did not explain the findings. While significant sex, racial, and ethnic disparities were present in both rural and urban areas, for the most part these disparities were ameliorated rather than accentuated in rural areas. Conclusion Contrary to expectations, our findings indicate that Medicare beneficiaries living in rural areas are more likely to undergo total knee or hip replacement surgeries. [source] Coverage and accuracy of ethnicity data on three Asian ethnic groups in New ZealandAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2010Pauline Norris Abstract Objective: Detecting and eliminating ethnic disparities in access to and outcomes of healthcare relies on accurate ethnicity recording. Studies have shown that there are inaccuracies in ethnicity data in New Zealand and elsewhere. This study examined coverage and accuracy of ethnicity data for three Asian ethnic groups. Methods: Student researchers from, or with links to, the ethnic groups concerned worked with communities to recruit participants. Names and dates of birth, length of residence in New Zealand and immigration status were recorded. Names and dates of birth were sent to the New Zealand Health Information Service, which attempted to link them with National Health Index ethnicity data. Results: Only 72% of participants could be linked to an NHI number, and only 48% of those had their ethnicity recorded accurately. Linkage odds were lower for older people, and accuracy was higher for Chinese people compared to the other ethnicities. Length of residence and immigration status did not affect either coverage or accuracy. Conclusion: Most participants who could be linked had their ethnicity recorded in the broader category of "Asian", but accuracy was poor at the sub-group level. Implications: Extreme caution should be applied when examining data about sub-groups within the ,Asian' category. [source] Improving survival disparities in cervical cancer between M,ori and non-M,ori women in New Zealand: a national retrospective cohort studyAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2010Melissa McLeod Abstract Objective: M,ori women in New Zealand have higher incidence of and mortality from cervical cancer than non-M,ori women, however limited research has examined differences in treatment and survival between these groups. This study aims to determine if ethnic disparities in treatment and survival exist among a cohort of M,ori and non-M,ori women with cervical cancer. Methods: A retrospective cohort study of 1911 women (344 M,ori and 1567 non-M,ori) identified from the New Zealand Cancer Register with cervical cancer (adenocarcinoma, adenosquamous or squamous cell carcinoma) between 1 January 1996 and 31 December 2006. Results: M,ori women with cervical cancer had a higher receipt of total hysterectomies, and similar receipt of radical hysterectomies and brachytherapy as primary treatment, compared to non-M,ori women (age and stage adjusted). Over the cohort period, M,ori women had poorer cancer specific survival than non-M,ori women (mortality hazard ratio (HR) 2.07, 95% confidence interval (CI): 1.63,2.62). From 1996 to 2005, the survival for M,ori improved significantly relative to non-M,ori. Conclusion: M,ori continue to have higher incidence and mortality than non-M,ori from cervical cancer although disparities are improving. Survival disparities are also improving. Treatment (as measured) by ethnicity is similar. Implications: Primary prevention and early detection remain key interventions for addressing M,ori needs and reducing inequalities in cervical cancer in New Zealand. [source] Colorectal cancer in U.S. adults younger than 50 years of age, 1998,2001,CANCER, Issue S5 2006Temeika L. Fairley PhD Abstract BACKGROUND. Colorectal cancer (CRC) incidence rates are increasing among persons younger than 50 years of age, a population routinely not screened unless an individual has a high risk of CRC. This population-based study focuses primarily on describing the CRC burden for persons in this age group. METHODS. The data used for this study were derived from the National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results (SEER) surveillance systems. Age-adjusted incidence rates, rate ratios, and their corresponding 95% confidence intervals were calculated. RESULTS. CRC is ranked among the top 10 cancers occurring in males and females aged 20,49 years regardless of race. Persons younger than 50 years were more likely to present with less localized and more distant disease than do older adults. Among younger adults, age-adjusted incidence rates for poorly differentiated cancers were twice as high as rates for well-differentiated cancers. Incidence rates for poorly differentiated cancers were 60% higher than that for well-differentiated cancers diagnosed in older adults. Rates were significantly higher for blacks and significantly lower for Asians/Pacific Islanders when compared with that for whites for the most demographic and tumor characteristics examined. CONCLUSIONS. This study confirms the findings of previous population-based studies suggesting that younger patients present with more advanced disease than do older patients. This study also identifies racial and ethnic disparities in CRC incidence in this population. These findings suggest the need for additional studies to understand the behavior and etiology of CRC in blacks. Cancer 2006. © 2006 American Cancer Society. [source] Interactions between genetic and reproductive factors in breast cancer risk in a population-based sample of African-American familiesGENETIC EPIDEMIOLOGY, Issue 4 2002Valérie Chaudru Abstract Incidence of breast cancer (BC) varies among ethnic groups, with higher rates in white than in African-American women. Until now, most epidemiological and genetic studies have been carried out in white women. To investigate whether interactions between genetic and reproductive risk factors may explain part of the ethnic disparity in BC incidence, a genetic epidemiology study was conducted, between 1989 and 1994, at the Howard University Cancer Center (Washington, DC), which led to the recruitment of 245 African-American families. Segregation analysis of BC was performed by use of the class D regressive logistic model that allows for censored data to account for a variable age of onset of disease, as implemented in the REGRESS program. Segregation analysis of BC was consistent with a putative dominant gene effect (P < 0.000001) and residual sister-dependence (P < 0.0001). This putative gene was found to interact significantly with age at menarche (P = 0.048), and an interaction with a history of spontaneous abortions was suggested (P = 0.08). A late age at menarche increased BC risk in gene carriers but had a protective effect in non-gene carriers. A history of spontaneous abortions had a protective effect in gene carriers and increased BC risk in non-gene carriers. Our findings agree partially with a similar analysis of French families showing a significant gene × parity interaction and a suggestive gene × age at menarche interaction. Investigating gene × risk factor interactions in different populations may have important implications for further biological investigations and for BC risk assessment. Genet. Epidemiol. 22:285,297, 2002. © 2002 Wiley-Liss, Inc. [source] No relationship observed between human p53 codon-72 genotype and HPV-associated cervical cancer in a population group with a low arginine-72 allele frequencyINTERNATIONAL JOURNAL OF IMMUNOGENETICS, Issue 3 2007V. A. Govan Summary Infection with high-risk human papillomavirus (HR-HPV) is a necessary but not a sufficient event in the development of cervical cancer, as most infections regress without intervention. Thus, genetic host factors and cellular immune responses could be potential modifiers for the risk of developing cervical cancer. In particular, p53 is considered as the most critical tumour suppressor gene and is involved in regulating cell division. The polymorphism on p53, which encodes either a proline or an arginine amino acid residue at codon 72, has been reported as a possible risk factor for cervical disease. This polymorphism has been shown to differentially affect the efficiency of degradation of p53 protein mediated by HR-HPV E6 oncoprotein. Women with histologically proven cancer of the cervix (n = 111) and hospital-based controls (n = 143) were included in this study. The patients and controls were from the Western Cape Province in South Africa. Genotyping of the p53 polymorphism was conducted using polymerase chain reaction and restriction fragment-length polymorphism method. The distributions of the allelic frequencies were stratified in both patients and controls into two South African ethnic population groups. In this study, we observed no association between the distribution of p53 polymorphism and susceptibility to cervical cancer in the Western Cape Province populations (P = 0.466). However, the frequency of the Pro/Pro residue at codon 72 was increased in the South African population when compared to Caucasians, Indians and Portuguese population groups. Notably, as the distribution of the Pro/Pro at codon 72 of p53 gene was significantly different (P < 0.05) between the control groups of South Africa and other population groups. This result suggests that ethnic disparity may influence the levels of p53 produced. [source] Burden of stroke in Maori and Pacific peoples of New ZealandINTERNATIONAL JOURNAL OF STROKE, Issue 3 2007Valery L. Feigin Studying ethnic particularities of stroke epidemiology may not only provide a clue to the causes of the observed racial/ethnic differences in stroke mortality but is also important for appropriate, culturally specific health care planning, prevention in stroke and improved health outcomes. This overview of published population-based stroke incidence studies and other relevant research in the multi-ethnic New Zealand population demonstrates an obvious ethnic disparity in stroke in New Zealand, with the greatest and increasing burden of stroke being imposed on Maori, who are indigenous, and Pacific people, who have migrated and settled in this country. These data warrant urgent and effective measures to be undertaken by health policy makers and health care providers to reverse the unfavourable trends in stroke and improve Maori and Pacific people's health. [source] Issues related to the diagnosis and treatment of autism spectrum disorders,DEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 2 2007Paul T. Shattuck Abstract This paper explores issues and implications for diagnosis and treatment, stemming from the growing number of children identified with autism spectrum disorders (ASDs). Recent developments and innovations in special education and Medicaid programs are emphasized. Eligibility determination policies, innovations in diagnostic practices, the cost and financing of assessment, variability among programs in diagnostic criteria, and racial/ethnic disparities in the timing of diagnosis all influence the capacity of service systems to provide diagnoses in a timely, coordinated, accurate, economical, and equitable manner. There are several barriers to the more widespread provision of intensive intervention for children with ASDs, including lack of strong evidence of effectiveness in scaled-up public programs, uncertainty about the extent of obligations to provide services under the Individuals with Disabilities Education Act, high cost of intervention, and variability among states in their willingness to fund intensive intervention via Medicaid. Innovative policy experiments with respect to financing intensive intervention through schools and Medicaid are being conducted in a number of states. © 2007 Wiley-Liss, Inc. MRDD Research Reviews 2007;13:129,135. [source] Disparities in Alcohol-Related Problems Among White, Black, and Hispanic AmericansALCOHOLISM, Issue 4 2009Nina Mulia Background:, This study assesses racial/ethnic disparities in negative social consequences of drinking and alcohol dependence symptoms among white, black, and Hispanic Americans. We examine whether and how disparities relate to heavy alcohol consumption and pattern, and the extent to which social disadvantage (poverty, unfair treatment, and racial/ethnic stigma) accounts for observed disparities. Methods:, We analyzed data from the 2005 U.S. National Alcohol Survey, a nationally representative telephone-based survey of adults ages 18 and older (N = 6,919). Given large racial/ethnic differences in abstinence rates, core analyses were restricted to current drinkers (N = 4,080). Logistic regression was used to assess disparities in alcohol-related problems at 3 levels of heavy drinking, measured using a composite variable incorporating frequency of heavy episodic drinking, frequency of drunkenness, and maximum amount consumed in a single day. A mediational approach was used to assess the role of social disadvantage. Results:, African American and Hispanic drinkers were significantly more likely than white drinkers to report social consequences of drinking and alcohol dependence symptoms. Even after adjusting for differences in heavy drinking and demographic characteristics, disparities in problems remained. The racial/ethnic gap in alcohol problems was greatest among those reporting little or no heavy drinking, and gradually diminished to nonsignificance at the highest level of heavy drinking. Social disadvantage, particularly in the form of racial/ethnic stigma, appeared to contribute to racial/ethnic differences in problems. Conclusions:, These findings suggest that to eliminate racial/ethnic disparities in alcohol-related problems, public health efforts must do more than reduce heavy drinking. Future research should address the possibility of drink size underestimation, identify the particular types of problems that disproportionately affect racial/ethnic minorities, and investigate social and cultural determinants of such problems. [source] Disparity vs Inequity: Toward Reconceptualization of Pain Treatment DisparitiesPAIN MEDICINE, Issue 5 2008CRNP, Salimah H. Meghani PhD ABSTRACT Context., "Disparity" and "inequity" are two interdependent, yet distinct concepts that inform our discourse on ethics and morals in pain medicine practice and in health policy. Disparity implies a difference of some kind, whereas inequity implies unfairness and injustice. An overwhelming body of literature documents racial/ethnic disparities in health. The debate on health disparities is generally formulated using the principle of "horizontal equity," which requires that individuals having the same needs be treated equally. While some types of health treatments are amenable to the principle of horizontal equity, others may not be appropriately studied in this way. The existing research surrounding racial/ethnic disparities in pain treatment presents a conceptual predicament when placed within the framework of horizontal equity. Objective., Using pain treatment as a prototype, we advance the conceptual debate about racial/ethnic disparities in health. More specifically, we ask three questions: (1) When may disparities be considered inequities? (2) When may disparities not be considered inequities? (3) What are the uncertainties in the disparity,inequity discourse? Discussion., Significant policy implications may result from the manner in which health disparities are conceptualized. Increasingly, researchers and policy makers use the term disparity interchangeably with inequity. This usage confuses the meaning and application of these distinct concepts. In a given health care setting, different types of disparities may operate simultaneously, each requiring serious scrutiny to avoid categorical interpretation leading to misguided practice and policy. While the science of pain treatment disparities is still emerging, the authors present one perspective toward the conceptualization of racial/ethnic disparities in pain treatment. [source] Differences in colorectal carcinoma stage and survival by race and ethnicityCANCER, Issue 3 2005Chloe Chien M.S. Abstract BACKGROUND In the United States, blacks with colorectal carcinoma (CRC) presented with more advanced-stage disease and had higher mortality rates compared with non-Hispanic whites. Data regarding other races/ethnicities were limited, especially for Asian/Pacific Islander and Hispanic white subgroups. METHODS Using data from 11 population-based cancer registries that participate in the Surveillance, Epidemiology and End Results program, the authors evaluated the relation among 18 different races/ethnicities and disease stage and mortality rates among 154,103 subjects diagnosed with CRC from 1988 to 2000. RESULTS Compared with non-Hispanic whites, blacks, American Indians, Chinese, Filipinos, Koreans, Hawaiians, Mexicans, South/Central Americans, and Puerto Ricans were 10,60% more likely to be diagnosed with Stage III or IV CRC. Alternatively, Japanese had a 20% lower risk of advanced-stage CRC. With respect to mortality rates, blacks, American Indians, Hawaiians, and Mexicans had a 20,30% greater risk of mortality, whereas Chinese, Japanese, and Indians/Pakistanis had a 10,40 % lower risk. CONCLUSIONS The authors observed numerous racial/ethnic disparities in the risks of advanced-stage cancer and mortality among patients with CRC, and there was considerable variation in these risks across Asian/Pacific Islander and Hispanic white subgroups. Although the etiology of these disparities was multifactorial, developing screening and treatment programs that target racial/ethnic populations with elevated risks of poor CRC outcomes may be an important means of reducing these disparities. Cancer 2005. © 2005 American Cancer Society. [source] | |||||||||||||