Minority Health: Recent Findings 3 ► Emergency Care/Hospitalization

Minority Health: Recent Findings

Emergency Care/Hospitalization

• Researchers examine trends in hospitalization for children with Kawasaki syndrome. Kawasaki syndrome (KS) is a rare childhood disease affecting the blood vessels that occurs most often among children aged 5 or younger of Japanese or other Asian ancestry living in Hawaii and the continental United States. This study found that children younger than age 5 accounted for more than 83 percent of all Kawasaki-related hospitalizations, and that higher hospitalization rates were observed for boys, children from higher income families, and children with private insurance. Japanese children had the highest incidence per 100,000 population (210.5), followed by Native Hawaiian children (86.9), other Asian children (84.9), and Chinese children (83.2).
  Source: Homan, Christensen, Belay, et al., Hawaii Med J 69:194-197, 2010. (AHRQ ·Publication No. 11-R004).* See also Holman, Belay, Christensen, et al., Pediatr Inject Dis J 29(6):483-488 (AHRQ Publication No. 11-R074)* (Intramural).
  

• Minority children with asthma often use emergency departments (EDs) for care. Researchers analyzed 1996-2000 data on 982 children with asthma and found that black and Hispanic children received asthma care in the ED more often than white children, which is consistent with findings from earlier studies. The authors suggest that additional ED visits occur because these children often lack a usual source of care and do not have a plan in place to manage asthma at home when an attack occurs. Thus, improving care access and offering programs to teach caregiver skills to manage asthma may reduce ED visits.
  Source: Kim, Kieckhefer, Greek, et al., Prev Chronic Dis 6(1):Epub, 2009 (AHRQ grant HS13110).

• Black children are more likely than white children to be hospitalized for a ruptured appendix. According to an analysis of data from AHRQ, the hospital admission rate of black children for a ruptured appendix in 2006 was 365 per 1,000 admissions, compared with 276 per 1,000 admissions for white children. Hispanic children had the second highest rate, 344.5 per 1,000 admissions, followed by Asian and Pacific Island children at 329 per 1,000 admissions.
  Source: See the 2009 National Healthcare Disparities Report, available at www.ahrq.gov/qual/nhdr09/nhdr09.pdf (Plugin Software Help) (Intramural).

• Blacks are less likely than whites to have surgery performed by high-volume surgeons and hospitals. Researchers examined data from New York City hospitals for 10 surgical procedures that have shown a direct relationship between volume and reduced short-term mortality. Examples include heart bypass surgery, total hip replacement, and certain cancer surgeries. For 9 of the 10 procedures, black patients were significantly less likely than whites to have their surgery performed by a high-volume surgeon or in a high-volume hospital. Asian and Hispanic patients also were more likely to have a less-experienced surgeon perform the procedure at a low-volume hospital.
  Source: Epstein, Gray, and Schlesinger, Arch Surg 145(2):179-180, 2010. See also Gray, Schlesinger, Siegfried, and Horwitz, Inquiry 46:322-338 (AHRQ grant HS14074).

• Researchers call for increased use of professional interpreters in hospitals. This study examined the correlation between limited English proficiency and hospital readmission rates and found that Chinese and Spanish speakers were more likely to be readmitted to the hospital than English speakers. When compared directly with English-speaking Asians and Latinos, the higher readmission rates persisted for those who spoke only Chinese and Spanish. Among English speakers, blacks had the highest and Latinos the lowest readmission rates. Since only 14 percent of the non-English-speaking patients used professional staff interpreters, the researchers cite the need to create a culture of professional interpreter use in hospitals.
  Source: Karliner, Kim, Meltzer, and Auerbach, J Hosp Med 5:276-282, 2010 (AHRQ grants HS10597 and HS11416).

• Hospitalization rates for HIV infection have declined, but disparities still exist. The annual rate of hospitalizations for HIV infection has declined consistently over the past few years, yet blacks, women, those infected with HIV through IV drug use, and older individuals are still hospitalized more often than other patients with HIV. Patients covered by Medicare, Medicaid, or a combination of the two were much more likely to be hospitalized than patients with private insurance.
  Source: Yehia, Fleishman, Hicks, et al., J Acquir Immune Defic Syndr 53(3):397-404, 2010 (AHRQ Publication No. 10-R046)* (Intramural).

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Health Care Access, Costs, and Insurance

• Being foreign-born negatively affects access to care. Using data on more than 6,000 nonelderly adults in the United States and Canada, researchers found that foreign-born adults in the United States were 48 percent less likely than native-born adults to have seen a health professional in the preceding 12 months. When they looked at the joint effects of nativity and race/ethnicity on access to care, the disparities were even greater. For example, foreign-born Hispanics had 55 percent lower odds of having a regular medical doctor than native-born non-Hispanic whites.
  Source: LeBrun and Shi, J Health Care Poor Underserved 22(3):1075-1100, 2011 (AHRQ grant T32 HS00029). See also Gresenz, Rogowski, and Escarce, Health Serv Res 44(5):1542-1562, 2009 (AHRQ grant HS10770)

• Many U.S.-Mexico border residents “cross over” to obtain health care services. Researchers conducted a survey among U.S. border residents living in Texas about seeking out health care services in Mexico. More than half of the 1,405 survey respondents said they crossed the border to use one of four types of services in Mexico: visits to doctors, medications, dental visits, and hospital admissions. Factors associated with crossing the border to obtain health care services included no health insurance, dissatisfaction with the quality of care in the United States, and self-reported poor health status. Nearly half of those participating in the survey did not have health insurance.
  Source: Su, Richardson, Wen, and Pagan, Health Serv Res 46(3):859-876, 2011 (AHRQ grant HS17003).

• Enrollment in Medicare Advantage plans reduces disparities in primary care quality in three States. According to this analysis of 2004 hospital discharge data from AHRQ's Healthcare Cost and Utilization Project, patients enrolled in Medicare Advantage managed care plans in California, Florida, and New York had a lower incidence of preventable hospitalizations across all racial/ethnic groups, compared with those enrolled in fee-for-service Medicare. According to the study’s author, better care coordination and use of primary and preventive care may be especially beneficial for minorities, since they often are vulnerable and need such support.
  Source: Basu, Health Care Manag Sci 15(1):15-28, 2012 (AHRQ Publication No. 12-R014)* (Intramural).

• Americans, especially blacks, spend substantial periods of time uninsured. Researchers used mortality data from the National Center for Health Statistics and data on health and health insurance status on 34,403 individuals participating in AHRQ's Medical Expenditure Panel Survey (MEPS) in 2004 to examine the risk of being uninsured. They found that among those aged 20-24, blacks were uninsured 43 percent of the time, compared with 36 percent of the time for same-age whites. Differences between blacks and whites were particularly large between the ages of 50 and 60, when health begins to decline and Medicare coverage has yet to begin.
  Source: Kirby and Kaneda, Demography 47(4):1035-1051, 2010 (AHRQ Publication No. 11-R037)* (Intramural).

• Some minority patients have difficulty accessing care provided by community health centers. Researchers studied access to care provided by four community health centers (CHCs) located in States with a higher-than-average percentage of Asian American, Native Hawaiian, and other Pacific Islander patients. They found that while the CHCs served as safety nets for some of the most vulnerable patients, many patients were unable to access or use the CHC care unless enabling services (e.g., language interpretation, health education, and financial or insurance eligibility assistance) were provided. Compared with nonusers, users of enabling services were more likely to be older, female, and uninsured.
  Source: Weir, Emerson, Tsent, et al., Am J Public Health 100(11):2199-2205, 2010 (AHRQ grant HS13401).

• Asian Americans enrolled in traditional fee-for-service Medicare receive fewer needed services than white patients. Researchers examined the association of race/ethnicity and socioeconomic status with the use of two Medicare-covered cancer screening services (colorectal cancer screening and mammography) and three diabetes-related care services (blood sugar measurement, eye exams, and self-care instructions) among elderly whites and Asian Americans. The study focused on the metropolitan statistical areas (MSAs) with the largest number of elderly Asians in 2000, including Los Angeles, New York City, and Washington, DC. Asians were less likely than whites to receive colorectal cancer screening and mammography, while Asian-white disparities in diabetes care were less consistent and varied according to geographic region. Outside of the nine MSAs studied, Asian-white differences were significant across both cancer screening services and all three diabetes services. Cancer is the leading cause of death among Asians, and diabetes-related conditions rank fifth.
  Source: Moy, Greenberg, and Borsky, Health Aff 27(2):538-549, 2008 (AHRQ Publication No. 08-R064)* (Intramural).

• HIV care sites serving a large proportion of blacks and Hispanics may be difficult to access for all patients. Researchers surveyed 915 HIV-infected adults receiving care at 14 U.S. HIV clinics and found that, on average, blacks and Hispanics spent more time traveling to the care site than whites (36 and 37 vs. 29 minutes). Further, travel time to the HIV care site lengthened as the proportion of black and Hispanic patients increased at a given site. Finally, waiting times at care sites were longer for Hispanics and blacks than whites (36 and 31 vs. 27 minutes).
  Source: Korthuis, Saha, Fleishman, et al., J Gen Intern Med 23(12):2046-2052, 2008 (AHRQ Publication No. 09-R032)* (Intramural). See also Ford, Daniel, Earp, et al., Am J Public Health 99(S1):5137-5143, 2009 (AHRQ grant T32 HS00032).

• Black and Hispanic Medicare patients often wait longer than white patients for surgery after hip fracture. According to this study, black and Hispanic Medicare patients with hip fractures had approximately a half-day delay in receiving hip stabilization surgery compared with white patients. Most often, the delay in surgery was due to the need to evaluate and stabilize other medical problems, such as chest pain. Other possible explanations include the higher prevalence in blacks and Hispanics of undiagnosed and uncontrolled medical conditions such as diabetes and hypertension or delayed transportation to the hospital leading to an afternoon admission and surgery deferral until the next day.
  Source: Nguyen-Oghalai, Kuo, Wu, et al., South Med J 103(5):414-418, 2010. See also Nguyen-Oghalai, Ottenbacher, Kuo, et al., Arch Physical Med Rehab 90:560-563, 2009 (AHRQ grant HS11618).

• Disparities in outpatient care and expenditures have widened for Hispanics but not for blacks. To explore trends in care disparities, researchers analyzed data on office-based or outpatient visits for two time periods: 1996-1997 and 2004-2005. They found that medical care spending for whites and blacks increased significantly (over $1,500) over those years, but there was a much smaller increase (about $400) in spending for Hispanics. Hispanic-white disparities in outpatient care visits increased between 1996 and 2005, while black-white differences remained relatively constant.
  Source: Le Cook, McGuire, and Zuvekas, Med Care Res Rev 66(1):23-48, 2009 (AHRQ Publication No. 09-R019)* (Intramural).

• Minority children are half as likely as white children to receive specialized therapies. This study found that 3.8 percent of children aged 18 or younger obtain specialized therapies from the health care system, including physical, occupational, and speech therapy and home health care services. Children most likely to use specialized therapies tend to be male (59.7 percent), white (80.6 percent), and have a chronic condition (38.8 percent). Black children, Hispanic children, and children of other races were much less likely than white children to receive special therapies. These findings suggest that either minority children are underusing therapies or white children are overusing them, according to the researchers.
  Source: Kuhlthau, Hill, Fluet, et al., Dev Neurorehabil 11(2):115-123, 2008 (AHRQ grant HS13757).

• More blacks than whites have trouble affording their prescription medicines. Researchers recruited elderly black and white patients from 48 primary care practices in Alabama. Patients were asked about their ability to pay for prescriptions, their insurance coverage, coexisting medical conditions, and socioeconomic status. Blacks were twice as likely as whites to not fill a prescription (50 vs. 25 percent) and were far more likely to report inadequate income to meet basic needs (61 vs. 17 percent). Of 399 participating patients, 53 percent had an annual household income of less than $15,000.
  Source: Cobaugh, Angner, Kiefe, et al., Am J Health Syst Pharm 65:2137-2143, 2008 (AHRQ grant HS10389).

• Immigrants use fewer preventive services than U.S. natives. Researchers compared use of preventive care services by immigrants and native-born residents and found that U.S. natives had more medical and dental visits, received more flu shots, and were screened more often for high cholesterol levels and cervical, breast, and prostate cancers. Although immigrants' use of preventive services increases the longer they stay in the United States, their use never matches that of U.S. natives. Immigrants are likely to be uninsured when they arrive in the United States, but even after they obtain continuous coverage, they still are less likely than U.S. natives to use preventive care.
  Source: Pylypchuk and Hudson, Health Econ; E-pub August 2008 (AHRQ Publication No. 09-R025)* (Intramural).

• Hispanics enrolled in Medicare managed care plans are less positive than whites about their care experiences. More than half of Hispanics insured through Medicare were enrolled in managed care programs in 2002. A 2002 survey included 125,369 respondents enrolled in 181 Medicare managed care programs nationally. Responses from white enrollees were compared with responses from Hispanic enrollees; also, responses from Hispanics who completed the survey in English were compared with those who completed the survey in Spanish. English-speaking Hispanics viewed all aspects of their care—except provider communications—worse than whites did. Spanish-speaking respondents reported more negative care experiences with timeliness of care, provider communications, and office staff helpfulness but were more satisfied with getting needed care.
  Source: Weech-Maldonado, Fongwa, Gutierrez, and Hays, Health Serv Res 43(2):552-568, 2008 (AHRQ grant HS16980). See also Basu, Friedman, and Burstin, J Health Care Poor Underserved 17:101-115, 2006 (AHRQ Publication No. 06-R028)* (Intramural).

• Researchers examine the effects of various factors on children's health insurance coverage. Children of different racial and ethnic groups vary substantially with respect to health insurance coverage. These researchers explored how much a given characteristic contributes to coverage differences, using a recently developed statistical technique—decomposition analysis. They found that observable characteristics such as poverty, parent educational level, family structure (for black children), and immigration-related factors (for Hispanic children) account for 70 percent or more of the coverage differences among white, black, and Hispanic children. They conclude that the lower coverage levels among ethnic and racial minorities are due to the fact that uninsurance is concentrated among socioeconomically disadvantaged children who happen to be minorities.
  Source: Pylypchuk and Selden, J Health Econ 27(4):1109-1128, 2008 (AHRQ Publication No. 08-R068)* (Intramural). See also Flores, Abreu, Brown, and Tomany-Korman, Ambul Pediatr 5(6):332-340, 2005 (AHRQ grant HS11305); Shone, Dick, Klein, et al., Pediatrics 115(6):697-705, 2005 (AHRQ grant HS10450); Simpson, Owens, Zodet, et al., Ambul Pediatr 5(1):6-44, 2005 (AHRQ Publication No. 05-R048)* (Intramural).

• Geographic information system may pinpoint areas where increased primary care is needed. Using the Multiple Attribute Primary Care Targeting Strategy (MAPCATS), researchers were able to identify geographic regions where increasing access to primary care services for the Hispanic community would have the greatest potential impact on health outcomes. They used MAPCATS to analyze five key attributes of the Hispanic population in Charlotte, NC: socioeconomic status, population density, insurance status, patterns of emergency department use, and use of the primary care safety net. The attributes were combined with input from health providers and community members to create a composite map that showed the community's overall primary care needs.
  Source: Dulin, Ludden, Tapp, et al., Am Board Family Med 23(1):109-120, 2010 (AHRQ grant HS16023).

• Some minority patients voice concerns about using telemedicine to expand access to care. Telemedicine holds promise as a way to compensate for physician shortages and overcrowding in inner city health facilities. This study found that inner city blacks and Hispanics view the benefits of the technology similarly, but blacks tend to be more wary of telemedicine. Their concerns centered mostly on the inability to check a doctor's qualifications and uncertainty about the telemedicine equipment's ability to protect privacy and confidentiality.
  Source: George, Hamilton, and Baker, Telemed J E Health 15(6):1-6, 2009 (HS14022).