Additional Studies
Latino families should be informed
about the dental health benefits of
drinking tap water.
According to this study, 40 percent of
Latino children never drink tap water
and are not receiving fluoride
supplements, putting them at
heightened risk of dental cavities.
Among all population groups, Latino
women are the most likely to avoid
drinking tap water because they fear it
will cause illness. The researchers
surveyed 216 parents of children cared
for in an urban public health center in
Utah and found that 30 percent of
parents never drank tap water, and 41
percent never gave it to their children.
They recommend that clinicians advise
Latino families about the safety, low
cost, and dental health benefits of
drinking tap water.
Source: Hobson, Knochel,
Byington, et al., Arch Pediatr Adolesc
Med 161:457-461, 2007 (AHRQ grant
HS11826).
Home routines in minority families
may hinder the development and
school success of children.
Researchers analyzed data from a 2000
survey involving a nationwide sample of
parents of 2,608 children aged 4 to 35
months. They found that black and
Hispanic children younger than age 3
experience multiple disparities in home
routines, safety measures, and
educational practices that could impede
their healthy development and future
success in school. For example, black
children were nearly twice as likely as
other children not to have regular
mealtimes, and black and Hispanic
children were more likely than white
children to never eat lunch or dinner
with their families. In addition,
minority parents were less likely than
white parents to install stair gates or
cabinet safety locks or to lower the
temperature setting on hot water
heaters to reduce burn risk, and they
also were less likely than white parents
to read to their children or to have
books in their homes.
Source: Flores, Tomany-Korman, and Olson, Arch Pediatr
Adolesc Med 159:158-165, 2005
(AHRQ grant HS11305).
Hospitalization of adults for sickle cell
disease remained stable from 1997 to
2004.
There is no cure for sickle cell disease,
which mainly affects African
Americans. The first Federal analysis in
a decade of sickle cell disease
hospitalizations found that admissions
of adults remained stable from 1997 to
2004. In 2004, approximately 83,000
hospital stays for sickle cell disease were
for adults, and 30,000 were for children
(2,000 of these stays were for infants).
Patients spent about 5 days in the
hospital, and costs averaged $6,223 per
stay ($500 million overall in 2004).
Medicaid paid for 65 percent of the
stays, Medicare for 13 percent, private
insurers for 15 percent, and 4 percent
were uninsured.
Source: Sickle Cell Disease
Patients in U.S. Hospitals, 2004, HCUP
Statistical Brief 21, available at
http://www.hcup-us.ahrq.gov/reports/statbriefs.jsp.
Disadvantaged blacks and whites have
different views on genetic testing.
According to this study of survey
responses by 314 low-income blacks
and whites being cared for in four
inner-city health centers in 2004, blacks
were three times as likely as whites to
believe that genetic testing would lead
to racial discrimination, but they were
four times as likely to think that all
pregnant women should have genetic
tests. The researchers note that blacks
were primarily concerned that genetic
testing results could lead to racially
based population control or could
block access to health insurance or
employment. They attribute blacks'
support for genetic testing of all
pregnant women to their concern about
sickle cell disease, which affects 1 in
600 black infants.
Source: Zimmerman,
Tabbarah, Nowak, et al., J Natl Med
Assoc 98(3):370-377, 2006 (AHRQ
grant HS10864). -
Researchers can safely omit race and
ethnicity from cesarean rate risk-adjustment
models.
Perinatal outcomes such as infant and
maternal death, prematurity, and
cesarean delivery are used as a measure
of the quality of obstetric care. These
less desirable outcomes are known to be
higher in the black population than in
the white population. The objective of
this study was to see if adding race and
ethnicity to an otherwise identical
model would improve the predictive
impact of the model. Researchers tested
two risk-adjustment models for primary
cesarean rates and found that the two
models did not differ substantially in
predictive discrimination or in model
calibration. They suggest that race and
ethnicity can safely be left out of
cesarean rate risk-adjustment models.
Source: Bailit and Love, Am J Obstet Gynecol 69:e1-e5, 2008 (AHRQ grant
HS14352).
Missing survey data complicates
comparisons across health plan
evaluations.
More data are missing from the
Consumer Assessment of Healthcare
Providers and Systems (CAHPS) survey
of health plans for elderly black
Medicare managed care enrollees than
for comparable white enrollees,
according to this study. The researchers analyzed CAHPS health plan survey
data collected from 109,980 Medicare
managed care enrollees in 321 health
plans to compare missing data and
reliability of health care evaluations.
They call for enhanced efforts to
improve the quality of data collected
from older blacks.
Source: Fongwa,
Cunningham, Weech-Maldonado, et
al., J Aging Health 18(5):707-721, 2006
(AHRQ grant HS09204). Self-rated health is a much stronger
predictor of mortality in whites than
in blacks.
Research over the past 20 years has
shown that how people rate their own
health is a strong predictor of mortality.
This is particularly true for better-educated
individuals, according to the
authors of this study. They examined
self-ratings of health and mortality
among 14,004 white and 2,428 black
adults aged 50 and older and found
that self-rated health was a much
stronger predictor of mortality in
whites than in blacks. For example,
whites who rated their health as poor
were more than 10 times as likely to die
as whites who rated their health as
excellent. On the other hand, blacks
who rated their health as poor were
three times less likely to die than whites
who rated their health as poor. The
researchers theorize that blacks may
value aspects of health that are less
associated with mortality.
Source: Lee, Moody-Ayers, Landefeld, et al., J Am Geriatr
Soc 55:1624-1629, 2007 (AHRQ grant
K02 HS00006).
Study examines American Indians'
participation in research.
According to this study, American
Indians are more likely to participate in
community-based research if it is being
conducted by a tribal college/university
or national organization, an American
Indian is leading the study, or the study
is addressing health problems of
concern to the American Indian
community.
Source: Noe, Manson, Croy, et al.,
Ethn Dis 17(Suppl 1):S6-S14, 2007
(AHRQ grant HS10854). Several barriers inhibit participation
in health promotion research by
Korean Americans.
Researchers analyzed barriers and
facilitators to recruiting Korean
Americans for 14 studies conducted
between 1998 and 2005 that addressed
prevalent problems affecting this
population, such as high blood
pressure. Aside from language barriers,
the patriarchal Korean culture forbids
women from participating in certain
social activities, including research
studies, and from seeking preventive
health care on their own. Community
barriers include low prevalence of
health care coverage (34 percent of this
population lacks insurance), lack of
awareness about research studies,
suspicions about consent procedures,
and concern about privacy and
confidentiality issues.
Source: Han, Kang, Kim,
et al., J Immigr Health 9:137-146, 2007
(AHRQ grants HS13160, HS13779).
See also Gollin, Harrigan, Calderon, et
al., Ethn Dis 15(Suppl 5):111-119,
2005 (AHRQ grant HS14022) Study examines risk of workplace
injury and how racial/ethnic
disparities in risk change over time.
The researcher estimated individual
workplace injury and illness risk over
time for a group of American workers
who participated in a 10-year study
(1988-1998) and found that white men
had a high risk of injury relative to
other groups (white women, black men
and women, and Latino men and
women). Among women, black women
had the highest risk of injury.
Source: Berdahl, J
Public Health 98(12):2258-2263, 2008
(AHRQ Publication No. 09-R020)*
(Intramural). Study results in culturally appropriate
survey instruments for use with
Hmong Americans.
Because of its history of refugee status,
low proportion of English speakers, and
cultural beliefs, the Asian Hmong
population in central California has low
involvement with health care
institutions. The researchers worked
with Hmong community leaders to
develop and focus-group test a
linguistically and culturally sensitive
survey that can be used to assess
knowledge about hypertension care in
this population.
Source: Wong, Mouanoutoua,
and Chen, J Cult Divers 15(1):30-36,
2008 (AHRQ grant HS10276). -
Researchers test a modeling design to
assess the effects of physician patient-centeredness
on patient trust.
This study used a two-factor
multigroup structural equation
modeling design to determine the effect
of physician patient-centeredness on
patient trust among predominantly
minority and disadvantaged patients
from an inner city medical practice.
The model fit well. It showed that
physician patient-centeredness
significantly influenced patient trust
and explained 82 percent of its
variability. Patient-centered physician
behaviors also increased patients'
confidence in and likelihood of
recommending their physicians.
Source: Aragon, Flack, Holland, et al., J Health
Disp Res Pract 1(1):63-74, 2006
(AHRQ grant T32 HS00032). See also
Napoles-Springer, Santoyo, Houston, et
al., Health Expect 8:4-17, 2005 (AHRQ
grant HS10599).
Researchers use three different
definitions of racial/ethnic disparities
to compare trends.
Using data from AHRQ's Medical
Expenditure Panel Survey (MEPS),
researchers used three different
definitions of racial/ethnic disparities to
compare trends in disparities and assess
the influence of changes in
socioeconomic status (SES) on those
trends. They used AHRQ's definition
of disparities, the Residual Direct Effect
(RDE) definition, and the Institute of
Medicine's (IOM's) definition. They
found that all three definitions told
basically the same story. However, for
most analyses measuring disparities at a
single point in time, the AHRQ
approach estimated the largest
disparities, and the RDE measured the
smallest disparities. The researchers
state a preference for the IOM's
definition because it comes the closest
to capturing the information most
critical for researchers and
policymakers.
Source: LeCook, McGuire, and
Zuvekas, Med Care Res Rev 66(1):23-48, 2009 (AHRQ Publication No. 09-R019)* (Intramural). See also Levine,
Briggs, Hollar, et al., Ethn Dis 17:280-283, 2007 (AHRQ grant HS11131).
American Indian/Alaska Native
patients are more likely than others to
report discrimination in health care.
Researchers conducted a telephone
survey of California adults in 2001 and
found that overall 7.1 percent of the
American Indian/Alaska Native group,
8.8 percent of the American
Indian/Alaska Native plus white group,
5.6 percent of blacks, 4.3 percent of
whites, and 2.6 percent of Asian
Americans reported discrimination in
health care at some point during the
preceding year.
Source: Johansson, Jacobsen,
and Buchwald, Ethn Dis 16:766-771,
2006 (AHRQ grant HS10854). Certain ethnic groups are difficult to
reach by mail for research or health
care reasons.
Communicating by mail with the 4
million American Indians and Alaska
Natives who live in the United States is
difficult, whether the communication
deals with their own health care or with
research projects germane to them,
according to this study. The researchers
sent a Native art calendar (with health
information for one group and without
such information for the other group)
via first class mail to 5,633 patients
who had been seen at an urban Indian
health clinic in the preceding 2 years.
Only 61 percent of patients actually
received the calendars. The mail
verification process was significantly less
likely to identify working addresses for
patients who were American
Indian/Alaska Native and those who
had been seen more than 3 months
before the study.
Source: Duffy, Goldberg, and
Buchwald, J Health Care Poor
Underserved 17:522-531, 2006 (AHRQ
grant HS10854). End-of-life decisionmaking varies
among and within ethnic groups.
Researchers conducted separate focus
groups among Japanese, Japanese-speaking
Japanese Americans, and
English-speaking Japanese Americans to
assess whether there were differences in
end-of-life decisionmaking due to
degree of acculturation. They found
that disclosure of a terminal diagnosis
became more acceptable with
acculturation. However, Japanese
Americans still preferred that the
diagnosis be disclosed first to the family,
who would then decide in what form to
communicate it to the patient. Japanese
Americans also trusted their physicians
more than the Japanese, who rejected
formal advance directives, consistent
with the less frequent personal use of lawyers in Japan compared with the
United States. All three groups
preferred a family-oriented
decisionmaking model to one based on
the autonomous individual, which
would not conform to the cultural
norms of many Japanese Americans.
Source: Bito, Matsumura, Singer, et al.,
Bioethics 21(5):251-262, 2007 (AHRQ
grant HS07370). Patient preferences for participating in
clinical decisionmaking vary by sex,
ethnicity, and age.
This study found that although most
people want to participate in making
decisions about their health care, at
least 50 percent of patients want the
final decisions to be made by their
physicians. A survey of 2,765 adults
revealed that nearly all respondents (96
percent) preferred to be offered choices
about their care and to be asked for
their opinions, but 44 percent preferred
to rely on their physicians for medical
knowledge rather than seeking out
information themselves. Preferences for
taking a more active role in
decisionmaking increased with age up
to 45 years but declined after that.
Blacks and Hispanics were more likely
than other groups to prefer that
physicians make the decisions, while
women were more likely than men to
prefer a patient-directed, active role in
decisionmaking.
Source: Levinson, Kao, Kuby,
and Thisted, J Gen Intern Med 20:531-535, 2005 (AHRQ grant HS09982).
See also Lara, Gamboa, Kahramanian,
et al., Annu Rev Public Health 26:367-397, 2005 (AHRQ grant T32
HS00008).
Study examines racial differences in
preferences for various health states.
Cost-utility analysis (CUA) is a form of
cost-effectiveness analysis that compares
the costs of health care programs with
their outcomes, which are measured in
terms of both quantity and quality of
life. The EuroQol Group's 5Q-5D
system—a type of CUA—can be used
to classify a respondent's current health
status and to indicate a preference for
that health state. This study examined
differences for EQ-5D health states
among black, white, and Hispanic
adults in the United States. Valuations
differed among the three groups for 7
of the 13 health states, and these
differences persisted after adjusting for
other sociodemographic factors.
Source: Shaw,
Johnson, Chen, et al., J Clin Epidemiol 60:479-490, 2007 (AHRQ grant
HS10243). -
Disability determinations for job-related
low back pain may reflect
racial inequities.
Researchers surveyed 580 black and
892 white individuals with
occupational low back pain from two
Missouri counties approximately 21
months after their worker
compensation claims had been settled.
They looked at several medical variables
as predictors of disability ratings,
including diagnosis and medical costs
and found that diagnosis and surgery
were strongly associated with disability
ratings at the time of case settlement. In
addition, race was associated directly
and indirectly with disability ratings
through association with diagnosis and
surgery. Blacks were significantly less
likely than whites to receive a diagnosis
of herniated disc (33 vs. 52 percent,
respectively) and/or to undergo surgery
(8 vs. 30 percent, respectively).
Source: Tait,
Chibnall, Andresen, and Hadler, J Pain 7(12):951-957, 2006. See also
Chibnall, Tait, Andresen, and Hadler,
Pain 114:462-472, 2005 (AHRQ grant
HS13087).
Black physicians were much more
likely than white physicians to practice
in HMOs in the 1990s.
According to this study, African
American physicians were 4.5 times as
likely as white physicians to practice in
health maintenance organizations
(HMOs) in the 1990s. After
controlling for greater debt among
African American physicians, their
tendency to locate in settings with more
African American patients (such as
HMOs), and organizational hiring
tendencies, African American
physicians still were 2.5 times as likely
as white physicians to practice in
HMOs. They also were one-third as
likely to be academic physicians or
physicians in large group practices and
two-thirds as likely to be hospital
physicians as their white colleagues.
These findings are based on a survey of
3,705 young physicians who completed
residency between 1986 and 1989.
Source: Briscoe and Konrad, J Natl Med Assoc 98(8):1318-1325, 2006 (AHRQ grant
HS10861). Nearly half of urban American
Indians and Alaska Natives visit their
reservations each year.
Sixty percent of the more than 2
million American Indians and Alaska
Natives in the United States live in
urban areas. Many choose to travel
back to their reservations each year, but
little is known about how this travel
might be related to health. Researchers
surveyed more than 500 American
Indian/Alaska Native adults at a
primary care clinic in Seattle about
time spent visiting a reservation during
the preceding year. Strong Native
American cultural identification, the
presence of lung disease, the absence of
thyroid or mental problems, and greater
dissatisfaction with care were
independently associated with more travel to reservations. However, they
could not determine how often
respondents traveled to their
reservations to obtain health care.
Source: Rhoades, Manson, Noonan, and
Buchwald, J Health Care Poor
Underserved 16:464-474, 2005 (AHRQ
grant HS10854). Minorities and low-income
individuals are less likely than others
to use Web-based health services.
In this study of HMO members' use of
e-Health accounts, minority individuals
were significantly less likely than whites
to use electronic health services, such as
ordering prescription refills, requesting
information about medical or drug-related
issues, arranging for medical
appointments, and other routine
activities. Similarly, individuals living in
low-income communities were much
less likely than those living in more
affluent communities to use e-health
services.
Source: Hsu, Huang, Kinsman, et al.,
JAMIA 12(2):164-171, 5005 (AHRQ
contract 290-00-0015).
Return to Contents
National Healthcare Quality and Disparities Reports
Each year since 2001, AHRQ has
published two national reports that
present detailed information, including
charts and updated trend information,
on the quality of health care services
and disparities (by race and income) in
health care in the United States. Copies
of the most recent reports are available
from AHRQ.
National Healthcare Disparities Report,
2008 (AHRQ Publication No. 09-0002).*
National Healthcare Quality Report,
2008 (AHRQ Publication No. 09-0001).*
Return to Contents
For More Information
Copies of items in this brief that are
marked with an asterisk (*) are available
from the AHRQ Publications
Clearinghouse. To order a copy, call the
clearinghouse toll-free at 1-800-358-9295 or send an E-mail to
AHRQpubs@ahrq.gov. Please use the
AHRQ publication number when
ordering.
For additional information about
AHRQ's activities, funding for research,
or other topics, please visit the AHRQ
Web site at http://www.ahrq.gov. Questions
and comments regarding AHRQ's
minority health program may be
directed to:
Cecilia Rivera Casale, PhD
Senior Advisor for Minority Health
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850
Phone: 301-427-1547
E-mail: Cecilia.Casale@ahrq.hhs.gov
Return to Contents
AHRQ Publication No. 09-P002
Replaces AHRQ Publication No. 06-P017
Current as of August 2009
Internet Citation:
Minority Health: Recent Findings. Program Brief. AHRQ Publication No. 09-PB003, August 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/minorfind.htm
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