Implications of race/ethnicity for health & health care Flashcards
LaVeist, Gaskin, & Richard. (2011). Estimating the economic burden of racial health inequalities in the United States.
Gist: Racial/ethnic disparities in health & health care impost costs on different aspects of society, both direct & indirect. There were three sets of analyses:
1) Direct medical costs (MEPS) - eliminating disparities for minorities would reduce direct medical care expenditures by ~$230 billion for 2003-2006.
2) Indirect costs (MEPS) - would reduce indirect costs associated w/illness & premature death by ~$1 trillion for 2003-2006. Two types of indirect costs on society: (a) lower work productivity & (b) losses from premature death.
3) Costs of premature death (National Vital Statistics Reports) - ~95% of indirect costs due to costs of premature death; 77% of all indirect costs attributed to health disparities accounted for by African Americans.
Social justice can also be cost-effective.
LaVeist et al. (2007). Overcoming confounding of race with socioeconomic status and segregation to explore race disparities in smoking.
Gist: Examined the nature of racial disparities in smoking status to investigate 2 major confounding factors in health disparities research: (1) racial segregation and (2) SES.
1) Using lifetime & current smoking status and # cigarettes smoked daily and adjusted for various sociodemographic variables.
2) Compared NHIS matched to data of a community in SW Baltimore, MD.
3) In adjusted models, whites had greater odds than blacks of current smoking & smoking more cigarettes in Baltimore sample (no differences in NHIS).
4) Unadjusted national estimates of racial disparities may be biased due to differential risk exposure among people of different race groups. Race differences in social & environmental contexts account partially for racial differences in smoking patterns.
5) Whites may be disadvantaged more greatly than blacks when living in a low-income urban environment (i.e., Baltimore).
Lara et al. (2013). Acculturation and Latino health in the United States: A review of the literature and its sociopolitical context.
Gist: Overview of concept of acculturation & review existing lit about relationships between acculturation & health/behavioral outcomes among Latinos. Acculturation has negative effect on substance abuse, dietary practices, & birth outcomes (associated with worse health outcomes, behaviors, or perceptions). For health care use & self-perceptions of health, effect of acculturation is mostly positive. Literature on acculturation & health lacks breadth & methodological rigor. General recommendations for 2 areas: public health practice & research-targeted.
Perreira & Telles. (2014). The color of health: Skin color, ethnoracial classification, and discrimination in the health of Latin Americans.
Gist: Health disparities in Latin America focus on gender, class, & regional health differences & downplay ethnoracial differences. Examined associations of interviewer-ascribed skin color, interviewer-ascribed race/ethnicity, & self-reported race/ethnicity with SRH. Looking at skin color discrimination, class discrimination, & SES. Found gradient in SRH by skin color. Those with darker skin colors report poorer health (primarily by increasing exposure to class discrimination & low SES).
LaVeist. (2002). Beyond dummy variables and sample selection: What health service researchers ought to know about race as a variable.
Gist: Race as a variable denotes social categories & not biological categoires. In health research, it’s typically a binary dummy variable used as a control in a regression. Race has also been sued as a sample selection variable. Both uses must have dustification.
1) Hypothesizes 2 underlying factors for race that are societal & cultural/ethnic: (a) societal - external to individual; (b) cultural/ethnic - individual-level behavior linked to cultural norms.
2) Recommendations: (a) race dummy variable does not measure culture, biology, values, or behavior (it measures skin color); (b) would be useful to collect ethnic identifiers for all groups & not just Hispanic; (c) need to develop more creative & precise measures for which race is a proxy (e.g., culture); (d) need to examine within- & between-group variation to see if there are race differences or variation w/in racial groups; (e) if going to exclude from analysis based on race, need theoretically grounded rationale.
Wong et al. (2002). Contribution of major disease to disparities in mortality.
Gist: All-cause mortality is higher with lower-educated individuals & blacks. Estimated cause-specific risks of death using NHIS to determine which diseases contributed most to disparities. Overall, smoking-related diseases related to increased risk of mortality for lower-educated individuals. Hypertension, HIV, diabetes, & trauma increased risk of mortality for blacks.
Satcher et al. (2005). What if we were equal? A comparison of the black-white mortality gap in 1960 and 2000.
Gist: Even with progress in decreasing the black-white gap, health inequalities persist. Examined trends in black-white SMRs for each age-sex group from 1960-2000. The black-white gap in SMR changed little btw 1960-2000 & got worse for infants & black men age 35+. SMR improved in black women. Using 2002, estimated 83,570 excess deaths each year could be prevented in US if black-white mortality gap eliminated.
Bhopal & Donaldson. (1998). White, European, Western, Caucasian, or what? Inappropriate labeling in research on race,ethnicity, and health.
Gist: The problem is the use of the term White in medical & epi literature. There has been debate over categories & terms for other racial/ethnic groups, but little discussion regarding the all-inclusive term of White. In US, captures all people of European-American & Arab-American categories.
1) Role of comparison population: (a) eases interpretation of variation by race/ethnicity; (b) Assess deviations from expectations; (c) assessment of racial/ethnic inequities.
2) Various terms for White: (a) hides heterogeneity of cultures.
3) By using “comparison population” as the term instead of White, forces researcher to better describe the comparison sample (& note heterogeneity of the group).
Fullilove. (1998). Comment: Abandoning “race” as a variable in public health research - an idea whose time as come.
Gist: Commented on Bhopal & Donaldson’s paper. Social & economic division of populations according to racial classifications (e.g., racial segregation in US, apartheid in South Africa, racial genocide in Germany) is based on assumption of inequality among races. Racism is the general term for systems promoting unequal treatment of racial groups. Questions 3 propositions for using race in health research:
1) if racism is a principal factor organizing social life & influencing health outcomes, then racial classification is important.
2) If racial classification is important, then health researchers must study people according to their races.
3) If people must be classified by race, then the use of politically derived racial classification systems is appropriate.
Issues with these: (a) if racism is principal factor, why not study racism instead of race?; (b) why use an unscientific system of classification in scientific research?
Other areas of study: (a) Understanding ways in which we organize social & economic relationships within bounded areas (“place”); (b) understanding of ethnicity; (c) consider equality as a subject of research.
Murray. (2003). Sick and tired of being sick and tired: Scientific evidence, methods and research implications for racial and ethnic disparities in occupational health.
Gist: Racial/ethnic disparities in occupational health have not been well studied. This review provides patterns of employment by education, gender, & race/ethnicity and how these patterns cause disproportionate exposure leading to disproportionate disease & injury.
1) There are many gender, racial, & ethnic “job ghettos”.
2) Case studies - miners, steelworkers, textile workers, etc.
3) Unemployment rates fluctuate but have historically been higher for workers of color (esp. blacks). Unemployment creates stressors that pose health risks.
4) Methodological issues: (a) historical reluctance to dedicate resources to document occupational disease & injury b/c adverse impact on profit margins; (b) no reliable data for racial/ethnic makeup of labor force; (c) health care providers receive little or no training in environmental & occupational health; (d) lack tools with appropriate sensitivity & specificity to diagnose early biological changes from most occupational exposures; (e) exact toxicants & doses of exposure to workers are usually unknown & poorly estimated; (f) interactions of multiple exposures poorly understood.
5) Strategies: Unclear about how minorities suffer disproportionate burden of occupational disease & industry today (research on past); elimination of job ghettos & job discrimination; eliminate most hazardous substances from workplace; keep workers from exposure; more primary care provider education in these areas; improve resources at federal/state/local levels to inspect & monitor workplaces; establish surveillance data & tracking.
Levine et al. (2001). Black-white inequalities in mortality and life expectancy, 1933-1999: Implications for Healthy People 2010.
Gist: Healthy People 2010 had goals of eliminating racial/ethnic health disparities that were based on absolute improvements in life expectancy & mortality. The current study determined whether there was evidence of relative improvement ( a more valid measure of inequality). Using historical data from the NCHS & the Census Bureau to predict future trends in relative mortality & L.E. using Autoregressive Integrated Moving Average (ARIMA) model, they found that forecasts for relative black-white age-adjusted, all-cause mortality & black-white L.E. at birth showed trends towards increasing disparities. From 1979 when Health People initiative started to 1998, the black-white ratio of age-adjusted, gender-specific mortality increased for all except 9 causes of death accounting for majority of U.S. mortality. From 1980-1998, ave. #’s of excess deaths per day among blacks relative to whites increased by 20%. Overall, there has been no sustained decrease in black-white inequalities in age-adjusted mortality or L.E. at birth since 1945. Need fundamental changes.
