America, all things not being equal

Objectives. To determine the impact of disaggregated mortality and health surveillance data on the ability to identify health disparities for American Indian and Alaska Native (AI/AN) subpopulations. Methods. We conducted a systematic review of reporting categories for AI/AN decedents on official death certificates for all 50 US states. Using public data from the 2017-2018 California Health Interview Survey (CHIS), we conducted bivariate and multivariate analyses to assess disparities in health conditions and outcomes for tribally enrolled and non‒tribally enrolled AI/AN persons compared with non-Hispanic Whites. Results. There was no standard for the collection of tribal enrollment data or AI/AN race on death certificates across all 50 states. There were stark differences in the incidence and prevalence of various health risk factors and chronic diseases for the tribally enrolled AI/AN subpopulation, non‒tribally enrolled AI/AN subpopulation, and non-Hispanic White comparison group. Conclusions. The collection of tribal enrollment data in vital statistics and health surveillance systems is necessary to identify and respond to health disparities among AI/AN subpopulations. These efforts must be conducted in partnership with tribal nations and consider Indigenous data sovereignty.

Impact of Health Literacy on Eye Health Disparities

Identifying health status and disparities for Indigenous populations is the first logical step toward better health. We compare the mortality profile of the American Indian and Alaska Native (AI/AN) population with that of non-Hispanic whites in the Haudenosaunee Nations in New York State, the Indian Health Service (IHS) East region (Nashville Area) and the United States. Data from the linkage of IHS registration records with decedents from the National Death Index (1990-2009) were used to identify AI/AN deaths misclassified as non-AI/AN. Analyses were limited to persons of non-Hispanic origin. We analyzed trends for 1990-2009 and compared AI/AN and white persons in the Haudenosaunee Nations in New York State, IHS East region and the United States. All-cause death rates over the past two decades for Haudenosaunee men declined at a greater percentage per year than for AI/AN men in the East region and United States. This decrease was not observed for Haudenosaunee women with all-cause death rates appearing to be stable over the past two decades. Haudenosaunee all-cause death rates were 16% greater than that for whites in the Haudenosaunee Nations. The most prominent disparities between Haudenosaunee and whites are concentrated in the 25-44 year age group (Risk Ratio=1.85). Chronic liver disease, diabetes, unintentional injury, and kidney disease death rates were higher in Haudenosaunee than in whites in the Haudenosaunee Nations. The Haudenosaunee cancer death rate (180.8 per 100,000) was higher than that reported for AI/AN in the East (161.5 per 100,000).Haudenosaunee experienced higher rates for the majority of the leading causes of death than East AI/AN. These results highlight the importance of Haudenosaunee-specific data to target prevention efforts to address health disparities and inequalities in health.

Structural racism and health inequities in the USA: evidence and interventions

COUNTERPOINT: Is Considering Social Determinants of Health Ethically Permissible for Fair Allocation of Critical Care Resources During the COVID-19 Pandemic? No

The Affordable Care Act 10 Years In: What Nursing Leaders Should Know

Cancer is a leading cause of death in the United States especially among racial and ethnic minorities, and other medically underserved populations. Cancer disparities are an important public health issue with health communication implications particularly for African Americans. African Americans have the highest mortality rate and shortest survival rate for most cancers. Reducing the cancer burden depends on early detection through preventative screening and addressing social determinants of health that drive cancer health inequities. Despite the evidence that adherence to providers’ recommendation of cancer screening guidelines decreases incidence and mortality rates, participation in cancer screening remain low among African Americans due to social and economic factors. The reasons for cancer-related health disparities are multifactorial and encompass physician and patient barriers. Medical distrust has emerged as a significant issue impacting cancer prevention especially during the coronavirus disease (COVID-2019) pandemic. Mistrust of the medical and research communities reflects the history of abuse and discrimination in the U.S., and has resulted in disparate health outcomes, as well as less frequent use of preventive health services. It is critical that populations at increased cancer risk have access to trusted, credible cancer health information and medical services to promote adherence to screening recommendations. To address this need, this cross-sectional study will examine the patient-provider communication practices among African American adults receiving primary care in the District of Columbia and their adherence to breast, cervical, colon and prostate cancer screening recommendations during the COVID era. The study is guided by an understanding of the social determinants of health. Specifically, the study will examine the relationship of trust, structural racism, and religiosity on cancer prevention behavior. The project will describe the perceptions of health inequities within the healthcare system and trust in cancer information sources that influence cancer screening behaviors among African Americans. This project is relevant to the reduction of cancer disparities and cancer prevention for African Americans. Patient-provider communication is a known barrier and facilitator of cancer screening behavior where an awareness of historical distrust of medical institutions, systemic racism, and religiosity are important factors in providing culturally appropriate care. The results of this pilot project will be used to inform best practices for patient-provider communication for cancer prevention. Findings will be used to develop culturally tailored interventions to promote compliance for cancer screening during the COVID era and beyond. Citation Format: Finie Hunter-Richardson, Pamela L. Carter-Nolan, Carla D. Williams, Mark S. Johnson. Addressing medical distrust among African Americans and adherence to cancer screening recommendations during COVID-19 [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A008.

Health Systems Need to Transform Data Collection to Advance Health Equity.

Reducing social inequalities in health is a priority in European policy and the UN’s Sustainable Development Goals. We aim to estimate the magnitude of health inequalities in Norway, a high-income country with a universal health care system but rising income inequality. Using survey and registry data, we estimated relative and absolute inequality in self-reported health, health behaviours and mortality by education and income, using the Relative and Slope Index of Inequality (RII/SII). Social disparities in health were evident across nearly all outcomes, for both income and education and for both sexes. Significant RIIs were found for self-reported health, long-standing health problems, global activity limitations, dental health and the behavioural risk factors of smoking, obesity, physical inactivity, low fruit (women only) and vegetable intake, and various causes of deaths. Inequality by income were particularly pronounced for mortality among men, with the RII for men’s all-cause mortality reaching 6.2 (CI 5.9–6.5) for income, compared to 3.6 (3.5–3.8) for education. SIIs were also significant for all outcomes, except for fruit intake for education among men. Thus, despite its extensive welfare system, income- and education-related health inequalities persist in Norway, highlighting the need for targeted policy interventions. Proportionate universalism may be a valuable strategy to address these disparities within European efforts to improve public health.

The Affordable Care Act (ACA) expanded access and assistance to many Americans, but health care remains prohibitively expensive for some, including people with insurance. The COVID-19 pandemic brought to the forefront the precarious conditions of those facing financial and health crises, including American Indians and Alaska Natives (AI/ANs). Theoretically, AI/ANs should have some insulation because of their health care access through Indian Health Service (IHS) and ACA Tribal health insurance options. We use 2018 National Financial Capability Study's survey data to examine household medical debt and cost avoidance behaviors. Findings show AI/ANs are more likely to have medical debt and skip filling prescriptions due to costs than non-Hispanic Whites. Implications are AI/ANs may face financial and health burdens due to insufficient health coverage, possibly exacerbated by the shortcomings of IHS or other underlying factors. Future research should use a qualitative approach to elucidate factors influencing health care finances and behaviors of AI/AN communities.

50 years of the inverse care law

Feminism is for everybody

Objectives: Health inequality is associated with profound social, health and economic costs. Despite extensive studies about inequality in health outcomes, our understanding of inequality in self-rated health is quite limited. This study aimed to determine the inequality in self-rated health and its associated factors in Hubei populations, China. Methods: A cross-sectional questionnaire survey was conducted on the community residents purposively selected from six municipalities in Hubei province, China. Participants were asked to rate their health on a five-point Likert scale, ranging from 1 to 5. A total of 1336 valid questionnaires were collected. Inequality in self-rated health was assessed using concentration index and further decomposed to measure sociodemographic inequality in the health of residents. Results: Two thirds (66%) of respondents rated their health as “excellent/very good/good”, while 34% rated it as fair or poor. The income-related concentration index was 0.0321 (95% CI, 0.0229 to 0.0413), indicating a concentration of poor self-rated health in the low-income groups. The CI of SRH in urban areas was 0.0239, which was lower than that in rural areas (0.0379). Age (17.5%) made the biggest contribution to the inequality in SRH, which was followed by employment (15.7%), income (8.5%), education (4.5%) and physical exercise (3.0%). Conclusions: There exist socioeconomic inequalities in self-rated health in Hubei, China. Policy priorities should be given to rural area, the older people and those with low economic participation.

Patient-Centered Outcomes Research: Early Evidence From A Burgeoning Field.

Introduction: Participation by American Indian and Alaska Natives (AI/AN) in clinical research may improve AI/AN health outcomes and generalizability of the research. Hypothesis: Cultural beliefs have a strong impact on willingness of AI/AN to participate in research. Methods: We developed a survey to identify if cultural beliefs impact perception of clinical research and the Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2) protocol. Stroke neurologists and CREST-2 investigators participated in the design of the survey. Participants were stratified based on AI/AN self-identification and level of education. Likert-scale responses were tested with the Mann Whitney-U test and dichotomous responses with the Chi-Square test. Results: There were 102 participants: 61% female, mean age 39, and 37% AI/AN. Eight questions evaluated understanding of research concepts within CREST-2; 89% of these responses were correct, with no significant difference in responses between AI/AN and non-AI/AN or between low (n=42) and high (n=60) education. Compared to other ethnic groups, AI/AN identify more with their culture (p=0.002) and consider cultural beliefs when making health care decisions (p=0.005), including participating in a research study (p=0.002). Using the same questions, we found no difference between respondents with low or high education.(Figure 1) Conclusion: These data support our hypothesis that cultural beliefs have a strong impact on AI/AN willingness to participate in research. It is important for researchers to consider cultural beliefs when designing recruitment strategies for AI/AN populations. Future work will address how cultural beliefs affect AI/ANs’ understanding of and willingness to participate in clinical research.