Tiffany L. Gary-Webb, PhD
Sherita Hill Golden, MD
Anne E. Sumner, MD
Health disparities refer to unequal health status or health care between groups of people due to differences in their background, physical traits, or their environment. Group differences include race/ethnicity, country of origin, sex, income, and disability. These and other differences can affect how often people in a group get a disease, how sick they are, and their chance of dying from the disease. Some people may not be able to get good health care or have the opportunity to make healthy lifestyle choices.
Unfortunately, health disparities affect large and diverse groups of people. They exist for many types of illnesses, including endocrine (hormone) disorders and diseases.
The Endocrine Society is working to better understand this major problem and to find solutions. It brought together a panel of experts to study the scientific evidence about health disparities in six common hormone conditions in the United States. These conditions include type 2 diabetes and its health complications, gestational (during pregnancy) diabetes, and the metabolic syndrome (a group of risk factors for diabetes and heart disease). The others are thyroid disorders and cancer, osteoporosis, and vitamin D deficiency.
This fact sheet gives an overview of the expert panel’s findings, by type of hormone problem. It will focus on racial and ethnic health disparities. Studies have found that access to health care—both prevention and treatment—tends to be lower for racial-ethnic minorities. (It is also worse for poor people, people with disabilities, and those living in rural areas.) Overall, some diseases have a greater impact on minorities, with delay in detection and treatment of disease and more advanced disease at diagnosis.
Often a mix of factors contributes to health disparities. These factors include:
Health disparities are complex, making it hard to pinpoint the exact cause of racial-ethnic disparities.
Compared with white adults, minority adults are more likely to
Frequency: In the United States, type 2 diabetes affects 16 percent of Native Americans and Alaska Natives, nearly 13 percent of blacks, almost 12 percent of Hispanics, and more than 8 percent of Asian-Americans. This contrasts with 7 percent of whites who have a diabetes diagnosis, the Centers for Disease Control and Prevention reports. Higher obesity rates and different patterns of body fat distribution (more fat around the waist) among most minority groups are a main reason for their raised diabetes risk.
Complications: Diabetes can lead to many long-term health problems. Minorities with diabetes often become sicker than whites with diabetes do. A likely reason why is that minorities tend to have poorer blood glucose levels (blood sugar) and more high blood pressure.
Among people with diabetes, Hispanics, Asian-Americans, and blacks have a lower rate of cardiovascular disease (heart disease and stroke) than whites do. Blacks, though, are more likely than whites to die once they have this diabetic complication. The reasons are unclear but may relate to poorer access to high-quality health care. This includes less effective screening tests that could detect disease earlier.
Women who have new diabetes during pregnancy are more apt to develop type 2 diabetes later. Gestational diabetes is more common in Hispanics, Asians, and Native Americans than in whites or blacks. Yet, for some reason, black women who do get this type of diabetes are even more likely to develop type 2 diabetes than women of other races. This holds true even when the groups have the same body mass index, or BMI (a measure of body size).
The metabolic syndrome is the presence of any three of five risk factors for type 2 diabetes and heart disease. They are (1) central obesity—a large waistline, (2) low high-density lipoprotein (HDL) or “good” cholesterol, (3) high triglycerides (blood fats), (4) high blood pressure, and (5) high fasting blood sugar.
Differences affecting diagnosis: Blacks are less likely than whites to have high triglycerides and more likely to have low good cholesterol, high blood pressure, and central obesity. Thus, use of high triglycerides for diagnosing the metabolic syndrome may make it hard to detect risk for diabetes and heart disease in blacks.
Another challenge is knowing what waist size (also called waist circumference) to use when estimating disease risk. Current size cutoffs were determined in whites and not well studied in other groups. Use of these cutoffs may miscalculate the risk for diabetes and heart disease in other groups, such as Asian-American and black women.
Autoimmune thyroid disease: Women of Jewish descent are nearly two times more likely than other women to have thyroid disease caused by an overactive immune system.
Thyroid cancer: Among patients with thyroid cancer, blacks have lower survival rates at five years than do whites. A study of a large cancer database found that blacks are 2.3 times more likely to get the most aggressive form of thyroid cancer (anaplastic). Also, thyroid tumors more often are larger and found at a later stage in blacks. Both blacks and Hispanics are less likely than whites to have their thyroid cancer removed by an experienced surgeon who does a high volume of thyroidectomies (surgical removal of the thyroid). Blacks also have the lowest rate of receiving radioactive iodine treatment after surgery when this treatment is appropriate.
Among Asian-American women, Filipinos and Vietnamese have the highest rates of the most common type of thyroid cancer (papillary).
Fracture frequency: Fractures (broken bones) due to the bone-thinning disease osteoporosis are more common in white women than minorities. Yet black women are more likely to die than white women after breaking a hip. This may be because blacks are older and more often have other severe health problems at the time of fracture.
Gaps in diagnosis and treatment: Compared with whites, black women who had a fracture are less likely to receive a diagnosis of osteoporosis. And if they are at risk for fracture, black women receive preventive osteoporosis medicine less often than whites do.
A shortage of vitamin D in the body worsens bone health and may raise the risk for some other diseases. Low vitamin D is a common problem among all races and ethnic groups, but blacks have lower vitamin D levels than others. There likely are many reasons for blacks’ higher risk for vitamin D shortage. One reason is their dark skin lessens their ability to make vitamin D from the sun. Compared with whites, blacks also tend to have less intake of vitamin D from supplements and their diet.
Researchers are trying to find out what causes health disparities and what works to reduce these differences. But we need more research into racial and ethnic disparities in hormone diseases. More studies are needed on rates of osteoporosis-related fractures in minority men. Osteoporosis screening and prevention should target all races and ethnic groups.
Obesity and fat pattern distribution are key contributors to diabetes risk, especially among minorities. To better estimate the risk for diabetes and heart disease, we need ethnic-specific measures of central obesity.
Many public health programs have reduced disparities in diabetes care and have improved the quality of care in that disease. Use of similar multilevel programs, which target the community, policies, health providers and systems, and patients, may help decrease health disparities in other hormone problems.
Here are some ways you can help avoid or overcome health disparities.
You can also help yourself and others by taking part in a research study that compares differences that may add to health disparities. To find a study, go to www.ClinicalTrials.gov and search under “health disparities.”
Hormone Health Network (www.hormone.org)
The Endocrine Society (www.endocrine.org)
National Institutes of Health: Health Disparities (www.nlm.nih.gov/medlineplus/healthdisparities.html)