Statistics are an integral part in determining factors in health disparities. According to Lei Shen, assistant professor in SPH’s Division of Biostatistics, the kind of statistics used in studies of health disparities varies from study to study. When using statistical methods for health disparities, information collected
from the dominant group is compared with information of the minority group. These statistics include comparisons of disease incidence and prevalence, survival rate once a disease is contracted and quality of life. There are two kinds of problems that require appropriate statistical methods. “There are the questions of, is a
Socioeconomic status has real effects on health and medical care. Low-income Americans run the highest risk of being uninsured. Census bureau ﬁgures show that 24.3 percent of people with incomes below $25,000 were uninsured, almost triple the rate of 8.4 percent for people with incomes over $75,000. Low-income and uninsured populations are more likely to suffer from cardiovascular disease, infectious diseases, cancer and dental disease. Cost-effective operations may result in practices that create real or perceived barriers to low-income individuals. Policies with regard to the treatment of uninsured patients have a selective effect on the care of minorities when these populations have lower rates of insurance coverage. “For example, a provider might make a decision about treatment based on what he or she predicts about patient compliance. If you think a patient won’t get follow-up care, you might do more at the time you see them. Alternatively, if you think a patient does not have enough money to buy an expensive drug, you might prescribe a different medication,” said McAlearney. Schweikhart echoes this sentiment. “Sometimes it is difﬁcult to gain access, but once access is granted, there are still inequalities. Cultural competence is a problem that must be addressed because sometimes health care must be tailored to cultural needs,” she said. The 2004 National Healthcare Disparities Report from the U.S. Department of Health and Human Services reported that from 1992 to 2001, rates of late stage colorectal cancer were higher among blacks compared with whites. “Persons of any racial group, including whites, who are poor, have a lower level of education, and/or have inadequate health care coverage, are more likely to have higher incidence and/or higher mortality rates associated with cancer,” said
certain observed disparity a real phenomenon, or simply a spurious observation? And can it be explained by some factors such as differing rates of some genetic mutation or different typical socioeconomic levels?” said Shen.
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How to measure health disparities
Michele Shipp, Research Assistant Professor in the SPH’s Division of Health Behavior and Health Promotion. Shipp conducted a study in Alabama exploring how disparities in colon cancer are affected by race, ethnicity and socioeconomic status. She examined differences in incidence, stage at diagnosis, and method of therapy between blacks and white men and women diagnosed with colorectal cancer in that state. Shipp said colorectal cancer (CRC) is the second most common cause of cancer death in the United States. However, incidence and mortality are highest among African American men and women in the U.S. She hopes that the ﬁndings will contribute to the understanding of variations in stage at diagnosis, treatment and survival associated with CRC in white and black patients and the extent to which race and socioeconomic status may affect these outcomes. CDC has indicated that the future health of the nation will depend on how effectively the U.S. reduces health disparities. Success in closing these gaps could result in greater economic productivity and a better-informed public. These possibilities are just becoming apparent. “Awareness of and sensitivity to health disparities is relatively recent, and this has become more urgent because of recent studies showing that this is a big problem. However, the issue of health disparities is a long-term problem and we have only begun to study it,” said McAlearney.
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