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Health divides : where you live can kill you
Americans live three years less than their counterparts in France or Sweden. Scottish men survive two years less than English men. Across Europe, women in the poorest communities live up to ten years less than those in the richest. Revealing gaps in life expectancy of up to 25 years between places just a few miles apart, this important book demonstrates that where you live can kill you. Clare Bambra, a leading expert in public health, draws on case studies from across the globe to examine the social environmental, economic and political causes of these health inequalities, how they have evolved over time and what they are like today. Bambra concludes by considering how health divides might develop in the future and what should be done, so that where you live is not a matter of life and dealth. -- Provided by publisher.
Book
The Disproportionate Impact of COVID-19 on Racial and Ethnic Minorities in the United States
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected racial and ethnic minority groups, with high rates of death in African American, Native American, and LatinX communities. Although the mechanisms of these disparities are being investigated, they can be conceived as arising from biomedical factors as well as social determinants of health. Minority groups are disproportionately affected by chronic medical conditions and lower access to healthcare that may portend worse COVID-19 outcomes. Furthermore, minority communities are more likely to experience living and working conditions that predispose them to worse outcomes. Underpinning these disparities are long-standing structural and societal factors that the COVID-19 pandemic has exposed. Clinicians can partner with patients and communities to reduce the short-term impact of COVID-19 disparities while advocating for structural change.
Coronavirus disease 2019 (COVID-19) pandemic in the United States exposed racial disparities in morbidity and mortality. African Americans, LatinX, and Native Americans are disproportionately impacted by the disease due to biomedical and social factors brought by structural injustices.
Journal Article
Validity of Race and Ethnicity Codes in Medicare Administrative Data Compared With Gold-standard Self-reported Race Collected During Routine Home Health Care Visits
Misclassification of Medicare beneficiaries' race/ethnicity in administrative data sources is frequently overlooked and a limitation in health disparities research.
To compare the validity of 2 race/ethnicity variables found in Medicare administrative data [enrollment database (EDB) and Research Triangle Institute (RTI) race] against a gold-standard source also available in the Medicare data warehouse: the self-reported race/ethnicity variable on the home health Outcome and Assessment Information Set (OASIS).
Medicare beneficiaries over the age of 18 who received home health care in 2015 (N=4,243,090).
Percent agreement, sensitivity, specificity, positive predictive value, and Cohen κ coefficient.
The EDB and RTI race variable have high validity for black race and low validity for American Indian/Alaskan Native race. Although the RTI race variable has better validity than the EDB race variable for other races, κ values suggest room for future improvements in classification of whites (0.90), Hispanics (0.87), Asian/Pacific Islanders (0.77), and American Indian/Alaskan Natives (0.44).
The status quo of using \"good-enough for government\" race/ethnicity variables contained in Medicare administrative data for minority health disparities research can be improved through the use of self-reported race/ethnicity data, available in the Medicare data warehouse. Health services and policy researchers should critically examine the source of race/ethnicity variables used in minority health and health disparities research. Future work to improve the accuracy of Medicare beneficiaries' race/ethnicity data should incorporate and augment the self-reported race/ethnicity data contained in assessment and survey data, available within the Medicare data warehouse.
Journal Article
A workshop report on the causes and consequences of sleep health disparities
Abstract
Sleep deficiencies, which include insufficient or long sleep duration, poor sleep quality, and irregular timing of sleep, are disproportionately distributed among populations that experience health disparities in the United States. Sleep deficiencies are associated with a wide range of suboptimal health outcomes, high-risk health behaviors, and poorer overall functioning and well-being. This report focuses on sleep health disparities (SHDs), which is a term defined as differences in one or more dimensions of sleep health on a consistent basis that adversely affect designated disadvantaged populations. SHDs appear to share many of the same determinants and causal pathways observed for health outcomes with well-known disparities. There also appears to be common behavioral and biological mechanisms that connect sleep with poorer health outcomes, suggesting a link between SHDs and other health disparities observed within these designated populations. In 2018, the National Institute on Minority Health and Health Disparities, the National Heart, Lung, and Blood Institute, and the Office of Behavioral and Social Sciences Research convened a workshop with experts in sleep, circadian rhythms, and health disparities to identify research gaps, challenges, and opportunities to better understand and advance research to address SHDs. The major strategy to address SHDs is to promote integration between health disparity causal pathways and sleep and circadian-related mechanisms in research approaches and study designs. Additional strategies include developing a comprehensive, integrative conceptual model, building transdisciplinary training and research infrastructure, and designing as well as testing multilevel, multifactorial interventions to address SHDs.
Journal Article
COVID-19 And Racial/Ethnic Disparities In Health Risk, Employment, And Household Composition
abstract We used data from the Medical Expenditure Panel Survey to explore potential explanations for racial/ethnic disparities in coronavirus disease 2019 (COVID-19) hospitalizations and mortality. Black adults in every age group were more likely than White adults to have health risks associated with severe COVID-19 illness. However, Whites were older, on average, than Blacks. Thus, when all factors were considered, Whites tended to be at higher overall risk compared with Blacks, with Asians and Hispanics having much lower overall levels of risk compared with either Whites or Blacks. We explored additional explanations for COVID19 disparities-namely, differences in job characteristics and how they interact with household composition. Blacks at high risk for severe illness were 1.6 times as likely as Whites to live in households containing health-sector workers. Among Hispanic adults at high risk for severe illness, 64.5 percent lived in households with at least one worker who was unable to work from home, versus 56.5 percent among Black adults and only 46.6 percent among White adults.
Journal Article
“Can you see my screen?” Addressing Racial and Ethnic Disparities in Telehealth
Purpose of Review
Telehealth is an innovative approach with great potential to bridge the healthcare delivery gap, especially for underserved communities. While minority populations represent a target audience that could benefit significantly from this modern solution, little of the existing literature speaks to its acceptability, accessibility, and overall effectiveness in underserved populations. Here, we review the various challenges and achievements of contemporary telehealth and explore its impact on care delivery as an alternative or adjunct to traditional healthcare delivery systems.
Recent Findings
Given the COVID-19 pandemic, there has been a rapid acceleration in telemedicine adoption. Recent studies of telemedicine utilization during the pandemic reveal stark disparities in telemedicine modality use based on race, socioeconomic status, geography, and age.
Summary
While telehealth has great potential to overcome healthcare obstacles, the
digital divide
stands as a challenge to equitable telehealth and telemedicine adoption. Achieving health equity in telehealth will require the mobilization of resources, financial incentives, and political will among hospital systems, insurance companies, and government officials.
Journal Article