Health Disparities

What are health disparities?

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 differences can affect how often people from select groups get a disease, how sick they become, and their chance of dying from the disease. As a result, some people are prone to making unhealthy lifestyle choices or may not receive adequate health care.

Unfortunately, health disparities affect large and diverse groups of people. They exist for many types of illnesses, including endocrine (hormone) disorders and diseases. 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.

Why are there health disparities?

Often, a mix of factors contributes to health disparities, including:

  • Race or ethnicity
  • Sex
  • Age
  • Socioeconomic status (poverty)
  • Level of education
  • Neighborhood environment
  • Cultural beliefs
  • Language barriers
  • Disabilities
  • Poor access to health care
  • Individual health behaviors (e.g., smoking, alcohol abuse, lack of exercise)

Health disparities are complex, making it hard to pinpoint the exact cause of racial-ethnic disparities.

What are the racial-ethnic disparities?

Type 2 diabetes

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 African Americans, 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 increased 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 unhealthy (higher blood glucose (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. African Americans, though, are more likely than Caucasians to die once they have this diabetic complication. The reasons are unclear, but may relate to poorer access to high-quality health care, which could lead to less effective screening tests that could detect the disease earlier.

Gestational diabetes

Women who have new diabetes during pregnancy are more apt to develop type 2 diabetes later in life. Gestational diabetes is more common in Hispanics, Asians, and Native Americans than in Caucasians or African Americans. However, for reasons unknown, 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).

Metabolic syndrome

The metabolic syndrome is the presence of any three of five risk factors for type 2 diabetes and heart disease. They are:

  • central obesity—a large waistline
  • low high-density lipoprotein (HDL) or “good” cholesterol
  • high triglycerides (blood fats)
  • high blood pressure
  • high fasting blood sugar

Differences affecting diagnosis: African Americans are less likely than Caucasians 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 African-American women.

Thyroid disease

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, African Americans 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 African Americans. Both African Americans and Hispanics are less likely than whites to have their thyroid cancer removed by an experienced surgeon.  African Americans 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).

Osteoporosis

Fracture frequency: Fractures (broken bones) due to the bone-thinning disease, osteoporosis, are more common in Caucasian women than minorities. Yet, African American women are more likely to die than Caucasian women after breaking a hip. This may be because African American are older and more often have other severe health problems at the time of fracture.

Gaps in diagnosis and treatment: Compared with Caucasians, African American women who had a fracture are less likely to receive a diagnosis of osteoporosis. Even when African American women are at risk for fracture, they receive preventive osteoporosis medicine less often than Caucasian women.

Low vitamin D

A deficiency of vitamin D in the body worsens bone health and may raise the risk for 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 African Americans higher risk for vitamin D shortage. One reason is their dark skin decreases their ability to make vitamin D from the sun. Compared with Caucasians, African Americans also tend to have less intake of vitamin D from supplements and their diet.

What are the experts’ conclusions?

Researchers are trying to find out what causes health disparities and what works to reduce these differences, and 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 conditions.

What can I do to prevent health disparities?

Here are some ways you can help avoid or overcome health disparities.

  • Talk to your doctor about your risk. Ask what you can do to reduce your risk for these hormone conditions. Get a primary care doctor if you do not have one.
  • Ask questions. If you do not understand something your health care providers say, ask them to explain it. Ask for a translator if language is a problem.
  • Share in your health care decisions. Research shows patients who actively take part in their health care have better health than those who do not.
  • Share your health information with all your health providers. Also, make sure the doctor who takes care of you when you are in the hospital talks to your primary care doctor.
Get help and support.

Ask your family and friends to help you improve your health habits. Studies have shown that people with good social support have better health outcomes.

See a diabetes educator if you have diabetes. This health provider can help you better manage your diabetes.

Find local programs that help monitor your health, such as phone reminders to check your blood sugar or blood pressure.

If you live where healthy fresh foods are in short supply, ask your health provider to connect you with local groups that give out fresh fruit and vegetables.

Use a patient navigator if your health system has them.This navigator is a personal resource often used by patients with cancer and sometimes those with diabetes, and serves as their guide through the health care system. This person helps the patient find a medical translator, financial aid, transportation to the doctor or hospital, or other needs.

You can also help yourself and others by taking part in a research study that can help researchers better understand the factors that contribute to health disparities. While the results from these studies may not eliminate health disparities, they can still lead to new ways of decreasing the negative impact on the groups of people that are affected by such disparities.  To find a study you can participate in, go to ClinicalTrials.gov and search under “health disparities.”

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