Care for the Elderly/Long-Term Care

• Greater functional disability among older blacks and Latinos may be due in part to disparities in treatment and care quality.

  This study of community-dwelling adults aged 50 and older found that blacks and Latinos with physician visits and hospitalizations were significantly less able than same-aged whites to carry out activities of daily living. In addition, many of the blacks and Latinos in this survey had more mobility limitations than whites. Other predisposing factors (e.g., age and sex, chronic illness, and economic access to care) did not account for the greater disability among blacks and Latinos. These findings suggest that improving economic access to care may not be enough to guarantee equal access to high-quality care.

  Source: Bowen and Gonzalez, Gerontologist 48(5):659-667, 2008 (AHRQ grant HS13819).

• Racial disparities in care for the elderly persisted and even worsened for some procedures in the late 1990s.

  Researchers analyzed discharge data for New York and Pennsylvania hospitals for elderly patients undergoing three referral-sensitive hospital procedures during 1997 and 2001—coronary angiography, heart bypass surgery, and hip/joint replacement, all high-technology procedures that generally require referral to a specialist. Elderly blacks were 37 percent less likely than elderly whites to have received angioplasty in 1997. This disparity had widened considerably by 2001, to 48 percent. Disparities in hip/joint replacement among other races also increased over time relative to whites.

  Source: Basu and Mobley, Med Care Res Rev 65(5):617-637, 2008 (AHRQ Publication No. 08-R074)* (Intramural).

• Elderly blacks are less likely than same-age whites to recognize any risks with certain medicines.

  Researchers analyzed survey data on low-income, elderly individuals taking nonsteroidal anti-inflammatory drugs (NSAIDs); one-third of the study participants were black. They found that black patients were less likely than their white counterparts to recognize any risks inherent in taking either prescribed (31.3 vs. 49.6 percent, respectively) or over-the-counter (13.3 vs. 29.3 percent, respectively) NSAIDs. They also were less likely to report that their doctor had discussed potential NSAID-related gastrointestinal problems or told them to take medications to reduce NSAID-related ulcer risk.

  Source: Fry, Ray, Cobaugh, et al., Arthritis Care Res 57(8):1539-1545, 2007 (AHRQ grant HS10389).

• Elderly people commonly use herbs and vitamin-mineral supplements, but use varies by ethnicity.

  Elderly men and women using complementary and alternative medicine (CAM) therapies often don't mention it to their physicians, and physicians often don't ask about it, putting elderly people who take multiple medications at risk for serious complications. Researchers interviewed community-dwelling elders (125 white, 112 black, and 128 Hispanic) aged 77 and older and found that almost half of them (47 percent) used CAM. About 13 percent of whites, 16 percent of blacks, and 5 percent of Hispanics used herbs. Use of vitamin-mineral supplements, alone or in conjunction with herbs, also varied by ethnicity, with use by 54 percent of whites, 31 percent of blacks, and 38 percent of Hispanics. The researchers suggest that clinicians should routinely ask elderly patients about their use of CAM therapies.

  Source: Raji, Kuo, Snih, et al., Ann Pharmacother 39:1019-1023, 2005 (AHRQ grant HS11618).

• Black and white caregivers of rural patients with dementia have different coping styles.

  Caregivers of patients with dementia in rural Alabama typically are women ranging in age from early 20s to early 80s, and they provide an average of nearly 50 hours of care per week. Many are also working outside the home and providing care for another family member (e.g., a young child or another elderly person) an average of 31 hours per week. Nearly all of the caregivers used religion as a coping mechanism, but white and black caregivers had very different coping styles, according to this study. For example, black caregivers were more likely to participate in organized religious activities, and white caregivers were more likely to use prayer or another private religious activity. White caregivers were more likely than black caregivers to be married, older, have higher incomes, and have fewer problems paying bills. Also, white caregivers used more medications than black caregivers, and they were more likely to feel burdened by caregiving and to use acceptance and humor to cope.

  Source: Kosberg, Kaufman, Burgio, et al., J Aging Health 19:3-21, 2007 (AHRQ grant HS13189).

• Coping styles used by older women vary by race.

  Researchers examined the use of health care services, religiosity, and religious coping styles of 274 women (159 white and 115 black) aged 55 and older living in subsidized housing in Nashville, TN. Asking older women about their religiosity and religious coping style during health assessments could help nurses set goals to improve the health of minority and other older women. The study revealed that older black women perceive themselves to be more religious than white women. They reported more formal religious behaviors (e.g., church attendance) and personal religious behaviors (e.g., praying, reading the bible) than white women. The self-directing religious copying style (relying on oneself and not religion to cope with stressors) was associated with more physician visits for white women and fewer visits for black women. The deferring coping style (giving up responsibility to God for coping with stressors) was associated with more physician visits and hospital days for white women but fewer hospital days among black women. The collaborative coping style (offering up prayers but also seeking one's own solution) was associated with a high number of hospital days among black women but had no significant effect on health care use among white women.

  Source: Ark, Hull, Husaini, and Craun, J Gerontol Nurs 32(8):20-29, 2006 (AHRQ grant HS11640).

• Use of assistive devices by disabled individuals varies by age and race.

  Assistive devices help prevent injury and promote independence but are too often underused, according to this study. Researchers identified 7,148 mobility-impaired adults and examined the influence of age, race/ethnicity, and living arrangements on device use. They found that younger blacks are more likely than same-age whites to use the devices (e.g., wheelchairs, canes, or walkers), while Hispanics are less likely than whites to use assistive devices. They note that lower device use among the oldest blacks may be due to lower prevalence of uncontrolled diabetes and disabling chronic disease among blacks who survive to advanced ages. Also, Hispanic culture encourages informal caregiving by family and others, which may substitute to some extent for device use among younger Hispanics. As the care needs of elderly Hispanics increase with age, device use may become more acceptable and hence device use becomes more prevalent among this group.

  Source: Resnik and Allen, J Aging Health 18(1):106-124, 2006 (AHRQ grant T32 HS00011).

• Higher mortality rates among black Medicare enrollees in Tennessee are related to fewer doctor visits.

  Elderly black Medicare patients in Tennessee make fewer physician visits than their white counterparts, which is a significant reason for their higher mortality rates, according to this study. Researchers examined 5 years of data from Medicare physician billing records and 6.3 years of mortality followup data to assess physician-diagnosed health problems, health care use, and mortality among 665,887 Tennessee Medicare enrollees. Between 1996 and 2002, 38 percent of blacks died compared with 32 percent of whites. This disparity resulted in 4,164 excess deaths among black Medicare enrollees in Tennessee. Blacks made an average of 7.5 fewer trips to the doctor than same-age whites during the study period, yet Medicare costs were the same for both groups. This suggests that black patient physician visits were more often in response to serious illnesses that required greater physician attention.

  Source: Sherkat, Kilbourne, Cain, et al., J Health Care Poor Underserved 16:50-63, 2005 (AHRQ grant HS11640).

• Medical disparities are narrowing among Medicare beneficiaries.

  Researchers analyzed data on 1.5 million individuals enrolled in 183 Medicare managed care plans from 1999 through 2003 and found that an increasing percentage of black enrollees are being treated for diabetes, heart disease, and other serious conditions in accordance with quality measures. The percentage of black enrollees with diabetes who had their LDL cholesterol +levels measured rose from 61 percent in 1999 to 92 percent in 2003—a 31 percent gain—and the percentage that had their LDL levels controlled increased even more, by 46 percent (from 23 percent in 1999 to 66 percent in 2003). Similar gains were found for the percentage of black enrollees prescribed a beta-blocker drug within 7 days of hospital discharge for cardiac problems (from 64 percent to 93 percent).

  Source: Trivedi, Zaslavsky, Schneider, and Ayanian, N Engl J Med 353:692-700, 2005 (AHRQ grant HS10803).

• Urinary incontinence is common among black nursing home residents in the Southeast.

  Over half of the 3 million elderly Americans who are cared for in nursing homes are reported to suffer from urinary incontinence (UI), which is considered a key indicator of poor quality of care. This study found that UI is common among residents of nursing homes in the Southeastern United States, especially black residents. Researchers found that in 1999-2002, UI prevalence was 65.4 percent at nursing home admission and 74.3 percent after admission. After admission, 73.5 percent of whites and 78.1 percent of blacks were incontinent. Prevalence of UI at admission was greater than 50 percent in all eight States studied, and black residents had higher rates of admission UI than whites in all States. These differences indicate a lack of optimal care for blacks in the Southeastern region, note the researchers.

  Source: Boyington, Howard, Carter-Edwards, et al., Nurs Res 56(2):97-107, 2007 (AHRQ grant HS13353).

• Nursing home quality of care is affected by the home's profit status and surrounding community.

  Researchers examined quality of care at 408 urban nursing homes in New York and found that the racial composition and profit status of a nursing home, as well as the racial composition of the community in which a home was located, influenced the quality of care provided for both white and black residents. For example, black and white residents of nursing homes with higher proportions of black residents were less likely to be restrained, but they were more likely to receive antipsychotic drugs. Also, black and white residents of for-profit homes were more likely to be restrained, receive antipsychotic drugs, and suffer poor health outcomes than residents of nonprofit homes.

  Source: Miller, Papandonatos, Fennell, and Mor, Soc Sci Med 63:3046-3059, 2006 (AHRQ grant HS10322).

• Advance care plans of nursing home residents vary by race/ethnicity and other factors.

  This researcher used 1996 data from AHRQ's Medical Expenditure Panel Survey (MEPS) on a sample of 815 nursing homes and 5,899 residents to examine documentation of advance care plans among residents. Overall, about 53 percent of the population (3,105 residents) had at least one advance care plan, and do-not-resuscitate (DNR) orders were less common among blacks and Latinos than whites. Latinos were less likely to have feeding/medication/other treatment restrictions than blacks and whites, and living wills were less common among blacks and more common among residents aged 75 and older and those with psychiatric/mood disorders and heart disease. Finally, residents with Medicaid as their primary payer were less likely to have an advance care plan than residents with another payment mechanism.

  Source: Dobalian, Arch Gerontol Geriatr 43:193-212, 2006 (AHRQ grant HS00046).

• Traditional values underlie older Korean Americans' preference for informal long-term care arrangements.

  Traditional values, especially those of children's devotion and obligation to care for elderly parents, seem to underlie a preference for informal caregiving among older Korean Americans. This study involved a survey of 150 community-dwelling Korean Americans aged 60 and older who had lived in the United States for an average of 17 years. Only 16 percent of respondents said they would rely on paid helpers at formal care facilities in the event of a hip fracture; 35 percent said they would rely on informal caregivers at their own or their children's homes, and about half said they would rely on a combination of formal (paid care) and informal (care by a relative) care, also in their own home or their children's homes. When presented with a stroke scenario, 51 percent of respondents said they would rely on a formal care arrangement, 28 percent preferred an informal care arrangement, and 21 percent preferred a mixed care arrangement.

  Source: Min, J Aging Health 17(3):363-395, 2005 (AHRQ grant HS10785).

Return to Contents

Chronic Illness

• Use of a uniform treatment algorithm eliminates racial disparities in blood sugar control.

  According to this study, differences between blacks and whites in glycemic levels disappear in care settings where treatment is uniform, immediate care is facilitated, and medication is aggressively managed. Patients with type 2 diabetes (3,324 blacks, 218 whites) all made initial and 1-year followup visits; a subset of patients had an additional followup visit at 2 years. Patient adherence to treatment, number of visits, and provider behavior were similar for both groups. Initially, glycemic levels were higher in black patients than in white patients; at 1 year, the difference in glycemic levels had narrowed but remained significant. Among those who returned for a 2-year visit, (1,691 blacks, 114 whites), glycemic levels were no longer different.

  Source: Rhee, Ziemer, Caudle, et al., Diabetes Educ 34(8):655-663, 2008 (AHRQ grant HS07922).

• Study finds racial/ethnic differences in performance of diabetes self-management practices.

  Diabetes self-management practices (exercise, proper diet, foot care) can improve blood sugar control and reduce complications. Blacks and Hispanics are more likely than whites to have diabetes and diabetes-related complications, yet they are less likely to follow recommended diabetes self-management practices. In this study of 21,459 ethnically diverse patients with diabetes, blacks were 37 percent less likely to exercise than whites, and Hispanics were 36 percent less likely than whites to do home glucose testing. The researchers call for development of interventions tailored to the needs of diabetes patients from different racial/ethnic groups.

  Source: Nwasuruba, Khan, and Egede, J Gen Intern Med 22:115-120, 2007. See also Egede and Dagogo-Jack, Med Clin North Am 89:949-975, 2005 (AHRQ grant HS11418); Jiang, Andrews, Stryer, and Friedman, Am J Public Health 95(9):1561-1567, 2005 (AHRQ Publication No. 05-R071)* (Intramural).

• Providing free blood glucose monitors may encourage self-management among blacks with diabetes.

  Researchers used 1992-1996 electronic medical record data to examine racial differences in use of self-monitoring blood glucose (SMBG) equipment after onset of insurance coverage and rates of discontinuation of SMBG use 18 months later among 2,275 black and white patients with diabetes enrolled in a large HMO. Following implementation of the coverage policy, blacks were 33 percent more likely than whites to monitor their own blood glucose levels, but they also were more likely than whites to discontinue use of SMBG over time. After 18 months, 78 percent of blacks and 64 percent of whites had stopped self-monitoring of their blood glucose levels.

  Source: Mah, Soumerai, Adams, and Ross-Degnan, Med Care 44(5):392-397, 2006 (AHRQ grant HS10063).

• American Indian/Alaska Native individuals with diabetes receive good quality care for their condition.

  According to this study, urban and rural clinics providing diabetes care for American Indian/Alaska Native patients are adhering to nationally recommended care guidelines at a rate comparable to or surpassing the rates described for the general population. The researchers compared Indian health facilities' adherence to diabetes care guidelines for 710 American Indian/Alaska Native patients at 17 urban clinics with a random sample of 1,420 patients from 225 rural Indian health facilities. Urban patients were more likely than rural patients to have received formal diabetes education in the preceding 12 months, but there were no significant differences in completion of lab tests and immunizations between patients seen at urban and rural clinics.

  Source: Moore, Roubideaux, Noonan, et al., Ethn Dis 16:772-777, 2006 (AHRQ grant HS10854).

• Poor blood sugar control among low-income urban blacks may reflect limited health care access.

  Researchers examined clinical, socioeconomic, and health care access factors of 605 low-income individuals—predominantly urban blacks—with type 2 diabetes and found that health care access had the most direct effect on their glucose levels. The average glucose level among these patients was 8.7 for those who had no problems in accessing care, compared with 9.4 for those who had access problems (7 is normal), and 8.9 for those who easily accessed medications, compared with 9.2 for those who had trouble doing so. Glucose levels were 8.6 percent for patients who regularly received care in a doctor's office or clinic, compared with 9.5 for those who relied on acute care facilities, and 10.3 for those who had nowhere to go for care.

  Source: Rhee, Cook, Dunbar, et al., J Health Care Poor Underserved 16:734-746, 2005 (AHRQ grant HS09722).

• Trust in medical care does not differ by race among indigent people with diabetes.

  Distrust in the medical care system has been suggested as one reason for elevated morbidity and mortality related to diabetes among blacks compared with whites. However, this study found that trust in the medical care system did not appear to differ significantly by race or ethnicity among indigent patients with type 2 diabetes. Medical mistrust was not significantly correlated with blood sugar or lipid control or other health outcomes. However, more trusting patients felt more in control of their diabetes and reported better physical and mental health. These findings are based on survey responses of 216 people with type 2 diabetes recruited from an academic medical center's clinic for indigent patients.

  Source: Egede and Michel, Diabetes Care 29(1):131-132, 2006 (AHRQ grant HS11418).

• Latinos are more likely than whites to die before age 45 due to higher rates of chronic disease and homicide.

  Researchers linked 1986-1994 data on 24 health problems with death records through 1997 and found that Latinos had higher mortality rates than whites before age 45 and similar rates at older ages. Contributing most to excess years of life lost among Latino men were diabetes, HIV, liver disease, and homicide. For women, contributing factors were diabetes and HIV. Diabetes alone accounted for between 33 and 62 percent of the years of potential life lost among Latinos compared with whites.

  Source: Wong, Tagawa, Hsieh, et al., Med Care 43(10):1058-1062, 2005 (AHRQ grant HS10858).

• Underdiagnosis of chronic illness in minorities is linked to care access and affordability.

  Researchers correlated self-diagnosis of chronic medical and mental health conditions among 287 black and Latino heads of households in three urban public housing communities in Los Angeles County with a physician's diagnosis of the conditions. Overall, 85 percent of those interviewed said that they were suffering from at least one chronic condition, but only 43 percent claimed that they had been diagnosed by a physician. Only about one in five who said they suffered from arthritis, dental problems, or circulation problems had been diagnosed by a physician. Physician-based diagnosis of medical conditions was associated with five enabling factors: greater accessibility to medical services, affordability of care, availability of health information, continuity of care, and less financial strain. Need-for-care factors were not significant.

  Source: Ani, Bazargan, Bazargan-Hejazi, et al., Ethn Dis 18(2 Suppl 2):S2-105-S2-111, 2008 (AHRQ grant HS14022).

• Dialysis patients who are black are more likely to skip treatments.

  This study involved 739 patients with end-stage renal disease (ESRD) who were receiving dialysis for their condition. Of these, 67 patients were identified as "skippers" because they missed more than 3 percent of scheduled dialysis treatments. Patients who were black were more than twice as likely to skip treatments as other patients. In addition, patients who were smokers and/or users of illicit drugs were also more likely to skip their dialysis treatments. Skipped treatments and poor dietary adherence are strongly associated with increased risk of death among ESRD patients. During an average followup period of about 3 years, 316 of the 739 dialysis patients died.

  Source: Unruh, Evans, Fink, et al., Am J Kidney Dis 46(6):1107-1116, 2005 (AHRQ grant HS08365).

• Study finds racial/ethnic variation in parental perceptions of their children's asthma.

  Researchers interviewed parents of 739 children with persistent asthma in a Medicaid health plan in Massachusetts. Overall, 75 percent of parents believed their children could be symptom-free most of the time (75 percent Latino, 84 percent black, and 89 percent white). Also, 43 percent of Latino parents, 44 percent of black parents, and 55 percent of white parents said their children should have no emergency room visits or hospitalizations for asthma. Black (18 percent) and Latino (23 percent) parents were more likely than white parents (8 percent) to have competing family priorities "all of the time" or "most of the time" in addition to their child's asthma, even after adjusting for income, education, insurance, and other factors.

  Source: Wu, Smith, Bokhour, et al., Ambul Pediatr 8(2):89-97, 2008 (AHRQ grant T32 HS00063).

• Researchers examine use of controller medications among black children with asthma.

  In this study, the medical records of 300 black children with asthma enrolled in West Virginia Medicaid showed that most (90.3 percent) of the children received quick-relief medications, and about half (56 percent) had prescriptions for corticosteroids to forestall asthma attacks. Only 35 percent of children in this study made two trips to physicians' offices during the 1-year study period. Children who used an inhaled corticosteroid (38 percent) were more likely than those who did not to have regular primary care visits and less likely to be hospitalized or visit the emergency room because of their asthma.

  Source: Smith and Pawar, J Asthma 44:357-363, 2007 (AHRQ grant HS15390).

• Puerto Rican children are diagnosed with asthma more often than other children.

  According to this study of data on 46,511 children living in the United States between 1997-2001, Puerto Rican children—particularly those born in Puerto Rico—bear a much higher burden of asthma than other U.S. children. Over one-fourth of Puerto Rican children studied were diagnosed with asthma at some point, compared with 16 percent of black children, 13 percent of white children, and 10 percent of Mexican children. This higher asthma morbidity among Puerto Rican children was not explained by sociodemographic and other asthma risk factors (e.g., household smoking).

  Source: Lara, Akinbami, Flores, and Morgenstern, Pediatrics 117(1):43-53, 2006 (AHRQ grant T32 HS00008).

• Minority adults with asthma in urban areas use a disproportionate amount of acute care.

  Minority individuals living in the inner city are more likely than other groups to have asthma and to use a disproportionate amount of acute care (emergency room visits and hospitalizations) for their asthma symptoms. In East Harlem, for example, the asthma mortality rate is nearly 10 times as high as the national average. According to this study involving 198 adults hospitalized for asthma, increased emergency room visits and hospitalizations among minority adults in East Harlem are linked to lack of an established asthma care provider, language barriers, and allergy to cockroaches.

  Source: Wisnivesky, Leventhal, and Halm, J Allergy Clin Immunol 116(3):636-642, 2005 (AHRQ grants HS09973 and HS13312).

• Increased physical activity could lower American Indian elders' risk of chronic illness.

  American Indians and Alaska Natives (AI/ANs) report lower levels of leisure-time physical activity than other populations, putting them at elevated risk for obesity, hypertension, diabetes, and cardiovascular disease. According to this study, more educated AI/AN elders have higher levels of physical activity than their less-educated counterparts, which may reduce their risk for chronic illness. The researchers correlated education with physical activity among 125 sedentary AI/AN elders (50 to 74 years of age) who were enrolled in a 6-week trial. After controlling for health and other factors, groups at several educational levels differed significantly in caloric expenditure due to moderate to vigorous exercise, with the difference increasing significantly with higher levels of educational attainment.

  Source: Sawchuk, Bogart, Charles, et al., Am Indian Alsk Native Ment Health Res 15(1):1-17, 2008 (AHRQ grant HS10854).

• Knowledge and beliefs about lifestyle changes may contribute to ethnic differences in blood pressure control.

  Researchers surveyed 1,503 adults aged 50 and older to assess ethnic differences in awareness, knowledge, and beliefs about hypertension and their relationship to self-reported blood pressure (BP) control. They found that only 34 percent of all individuals with hypertension (BP greater than 140/90) had their BP controlled, and that ethnic differences in knowledge and beliefs about lifestyle changes were linked to difficulties in controlling BP among blacks. Blacks and Hispanics tended to view medication as the only way to control BP, while whites also saw the importance of changes in diet and exercise. More blacks said they had hypertension (64.2 percent) than Hispanics (44.3 percent) or whites (44.2 percent). Those who believed that lifestyle changes (e.g., weight loss, decreased alcohol and tobacco use, more exercise) were useful in treating high BP were more than twice as likely as those who discounted lifestyle changes to have better BP control.

  Source: Okonofua, Cutler, Lackland, and Egan, Am J Hypertens 18:972-979, 2005 (AHRQ grant HS10871).

• Differences in education and health status account for most of the racial/ethnic differences in physical activity.

  Leisure-time physical activity is associated with a lower risk for heart disease and cancer and better cardiorespiratory fitness. Blacks, Hispanics, and people with lower educational attainment participate less in leisure-time activities than whites and people with higher educational attainment. This analysis of 1992 data on 9,621 community-dwelling adults aged 51-61 revealed that education is a more important determinant of leisure-time physical activity than race/ethnicity. After adjustments were made for differences in overall health and physical functioning, mean total physical activity scores were similar across racial/ethnic and education categories.

  Source: He and Baker, J Gen Intern Med 20:259-266, 2005 (AHRQ grant HS10283).

• Greater access to care at VA clinics leads to improved blood pressure control among black men.

  Greater access to care at Veterans Affairs (VA) health care sites has led to better blood pressure (BP) control among black men, according to this study. Researchers compared BP treatment and control between black men (4,379 at VA centers and 2,754 at non-VA centers) and white men (7,987 at VA centers and 4,980 at non-VA centers) with high blood pressure. Blood pressure control to below 140/90 was comparable among white men with hypertension at VA and non-VA sites, while BP control was better among black men at VA sites than at non-VA sites. Compared with white men, black men received a similar number of prescriptions at VA sites and more prescriptions at non-VA sites. Yet, blacks had more visits at VA sites and fewer visits at non-VA sites than whites, suggesting that site of care—especially more visits—had greater impact on BP control in black men than in white men.

  Source: Rehman, Hutchison, Hendrix, et al., Arch Intern Med 165:1041-1047, 2005 (AHRQ grant HS10871).

• Distance learning is as effective as in-class training for Korean Americans with high blood pressure.

  Researchers involved the community in planning this study and recruiting the participants through Korean churches, grocery stores, and local Korean language publications. Participants were all first-generation Korean Americans, aged 40-65 years, who had high blood pressure (140/90 or higher) or were taking blood pressure medications. They were assigned either to the in-class group (184) or the mail education group (261). Both interventions provided information about blood pressure control and reducing risk factors, as well as other factors important to this population. At the end of the study, both groups showed comparable improvements in blood pressure control and in psychological and behavioral outcomes.

  Source: Kim, Kim, Han, et al., J Clin Hypertens 10(3):176-184, 2008. See also Kim, Han, Park, et al., J Cardiovasc Nurs 21(2):77-84, 2006 (AHRQ grant HS13160).

• Researchers examine knowledge and modifiable behaviors among Korean Americans with hypertension.

  This study of Korean American adults with hypertension found that overall, 63 percent of men and 82 percent of women had a family history of high blood pressure; more than 10 percent had diabetes, and 5 percent had already had a stroke. Women were more likely than men to have controlled blood pressure and to be on blood pressure medication. Women also had lower rates of smoking, drinking, and overweight/obesity than men. The goal of the study was to identify potentially modifiable lifestyle behaviors in this at-risk group.

  Source: Han, Kim, Kang, et al., J Community Health 32(5):324-342, 2007 (AHRQ grant HS13160).

• Nonadherence to antihypertensive medications by Korean Americans may indicate lack of knowledge.

  Nonadherence to antihypertensive medication regimens among 445 middle-aged Korean Americans in a self-help program was due primarily to inadequate understanding of their condition and the medication, according to researchers. About 55 percent of those in the group had been prescribed an antihypertensive medication. Among those not taking their medication, about 29.8 percent indicated it was unintentional, 2.4 percent said it was intentional, and 21.6 percent reported both types of nonadherence. Those whose nonadherence was intentional were significantly more likely than the others to have medication-related adverse effects, such as frequent urination at night, itching, heart pounding, dry mouth, and flushing of the face. Those who did not take their medication had substantially less knowledge about high blood pressure than those who were compliant.

  Source: Kim, Han, Jeong, et al., J Cardiovasc Nurs 22(5):397-404, 2007 (AHRQ grant HS13160).

• Low-income city-dwelling adults with high blood pressure are reasonably knowledgeable about their condition.

  This study of predominantly low-income black women with hypertension found that nearly two-thirds (65 percent) of them were fairly knowledgeable about their condition. Those with less knowledge tended to be at least 60 years of age, have less than a high school education, or be recently diagnosed with the condition. Individuals who were uncomfortable asking questions of their doctors also were less knowledgeable. Nearly one-fourth of the patients did not know that high blood pressure can cause kidney problems, despite the prevalence of kidney problems among blacks with hypertension. The study involved 296 adults being cared for at one urban clinic.

  Source: Sanne, Muntner, Kawasaki, et al., Ethn Dis 18:42-47, 2008 (AHRQ grant HS11834).

• Study finds variations among Asian subgroups in adherence to antihypertensive drug therapy.

  Researchers studied compliance with antihypertensive medication using a prescription database for 28,395 members enrolled in a large health plan in Hawaii from 1999 to 2003. Even after adjusting for physician and patient characteristics, Japanese patients were 21 percent more likely than whites to adhere to their blood pressure medication regimen, while Filipinos, Koreans, and Hawaiians were less likely than whites to follow their drug regimen (31, 21, and 16 percent, respectively). These findings indicate that ethnic subgroups need to be studied separately, note the researchers.

  Source: Taira, Gelber, Davis, et al., Ethn Health 12(3):265-281, 2007 (AHRQ grant HS11627).

• U.S. rates of Kawasaki syndrome are highest in Japanese American children living in Hawaii.

  Kawasaki syndrome (KS) is an autoimmune disorder that primarily strikes children under the age of 5 and leads to serious heart problems. KS primarily affects Japanese American children who live in Hawaii, suggesting there may be an environmental component to KS. Researchers analyzed data for Hawaii residents hospitalized for KS from 1996 through 2001 and found that 267 individuals age 17 or younger (85 percent were younger than age 5) were hospitalized for KS in the State. The average annual incidence of KS was 45.2 per 100,000 children under age 5 years. Incidence was highest for Japanese American children (197.7 per 100,000), followed by Asian/Pacific Islander children (70.9 per 100,000) and white children (35.3 per 100,000).

  Source: Holman, Curns, Belay, et al., Pediatr Infect Dis J 24(5):429-433, 2005 (AHRQ Publication No. 05-R073)* (Intramural).

• Blacks are more likely than whites to distrust the health care system, particularly with regard to organ transplantation.

  This study involved a telephone survey of 1,283 adults in Ohio who were asked whether they had signed a donor card and if they were willing to donate their own or a loved one's organs. Fewer blacks than whites had signed a donor card (39 vs. 65 percent, respectively) or were willing to donate their own (73 vs. 88 percent, respectively) or a loved one's (53 vs. 66 percent) organs. The study found that blacks are more distrustful of the organ donation system than whites and are in favor of providing tangible benefits to donor families. A second finding of note was the pervasive distrust of the health care system and a belief that it is inequitable.

  Source: Siminoff, Burant, and Ibrahim, J Gen Intern Med 21:995-1000, 2006 (AHRQ grant HS10047).

• Nearly one-fourth of black adolescent girls are overweight, putting them at increased risk for diabetes.

  Researchers conducted a pilot study of 12 overweight black girls ranging in age from 12 to 18 to determine why they are more likely than same-age white girls to be overweight (23.6 percent vs. 12.7 percent, respectively). The girls were in a hospital-based diabetes screening program. They were asked about their attitudes towards weight, diet, and physical activity. Their answers indicated that they were conditioned against the impact of hurtful, weight-related comments, and such comments did not motivate them to change their eating habits or physical activity levels. The girls used culturally based terms (e.g., big, thick, or skinny) to describe body size rather than an objective measure (e.g., weight). They preferred a range of acceptable sizes, self-satisfaction with size was more important than actual size, and they consistently described large body size as preferable.

  Source: Boyington, Carter-Edwards, Piehl, et al., Prev Chronic Dis 5(2):e-pub, 2008 (AHRQ grant HS13353). See also Edwards, Nurs Clin North Am 40(4):661-669, 2005 (AHRQ grant HS11834).

• Minority children living in public housing are at elevated risk for chronic illness.

  This study found that black and Latino children living in public housing communities are two to four times as likely as children in the general population to suffer from chronic physical and mental problems. Black and Latino children living in three such communities in Los Angeles, CA, were more likely than children in the general population to suffer from asthma (32 vs. 8 percent, respectively) and attention deficit hyperactivity disorder (17 vs. 5 percent, respectively). Other chronic conditions reported by parents included eye/vision problems, dental problems, and depression.

  Source: Bazargan, Calderon, Helin, et al., Ethn Dis 15(Suppl 5):3-9 (AHRQ grant HS14022).

• Poor literacy is linked to poor HIV medication adherence among blacks.

  In this study, blacks were more than twice as likely as whites to be nonadherent to their HIV medication regimen, but when literacy was added to the equation, the effect of race diminished by 25 percent to nonsignificance. Low literacy, on the other hand, remained significant and doubled the likelihood of not complying with prescribed antiretroviral medication use. The researchers examined patient demographics, health literacy, and race among 204 patients with HIV infection who were being seen in two clinics in 2001. They used an established word-recognition test to assess health literacy. These findings suggest that poor literacy may be a major contributor to HIV health disparities.

  Source: Osborn, Paasche-Orlow, Davis, and Wolf, Am J Prev Med 33(5):374-378, 2007 (AHRQ grant T32 HS00078).

• The HIV/AIDS epidemic in the U.S. South is shifting toward heterosexual transmission among blacks and women.

  HIV/AIDS infection in the United States is spreading most rapidly in the South, and its victims tend to be poor, minorities, and survivors of abuse, many of whom become infected through heterosexual contact. Also, HIV-infected women and blacks in the South are less likely than others to be on antiretroviral therapy, according to this study. It shows that more than half of patients with HIV from five Southeastern States suffer from probable psychiatric disorders, nearly a third have a history of childhood sexual abuse, and 21 percent have experienced severe physical abuse. Overall, nearly two-thirds of those studied were black (compared with 50 percent nationally), 31 percent were female (26 percent nationally), and 43 percent acquired HIV through heterosexual sex (28 percent nationally).

  Source: Pence, Reif, Whetten, et al., South Med J 100(11):1114-1122, 2007 (AHRQ grant T32 HS00079).

• Blacks and Latinos are less likely than whites to report discrimination after HIV diagnosis.

  One-fourth of U.S. adults receiving care for HIV believe that their clinicians discriminated against them after the onset of their infection, according to survey data collected in 1996 and 1997. Whites (32 percent) were more likely than Latinos (21 percent) and blacks (17 percent) to report discrimination. Patients who reported discrimination also reported lower access to care, lower quality of physician and hospital care, and less trust in doctors or clinics compared with patients who did not report discrimination.

  Source: Shuster, Collins, Cunningham, et al., J Gen Intern Med 20:807-813, 2005 (AHRQ grant HS08578).

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