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Takagi MA, Rhodes ST, Kim JH, King M, Soukar S, Martin C, Sasaki Cole A, Chan A, Brennan C, Zyzanski S, Kissoondial B, Ragina N. Evaluating Two Educational Interventions for Enhancing COVID-19 Knowledge and Attitudes in a Sample American Indian/Alaska Native Population. Vaccines (Basel) 2024; 12:787. [PMID: 39066425 PMCID: PMC11281502 DOI: 10.3390/vaccines12070787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 07/15/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has exacerbated existing healthcare disparities among American Indian/Alaska Native (AI/AN) populations rooted in historical traumas and systemic marginalization. METHODS This study conducted at a single Indian Health Service (IHS) clinic in central Michigan evaluates two educational interventions for enhancing COVID-19 knowledge and attitudes in a sample AI/AN population. Utilizing a pre/post-intervention prospective study design, participants received either a video or infographic educational intervention, followed by a survey assessing their COVID-19 knowledge and attitudes. RESULTS The results indicate significant improvements in knowledge and attitudes post-intervention, with both modalities proving effective. However, specific factors such as gender, political affiliation, and place of residence influenced COVID-19 attitudes and knowledge, emphasizing the importance of tailored interventions. CONCLUSIONS Despite limitations, this study highlights the critical role of educational interventions in addressing vaccine hesitancy and promoting health equity within AI/AN communities. Moving forward, comprehensive strategies involving increased Indian Health Service funding, culturally relevant interventions, and policy advocacy are crucial in mitigating healthcare disparities and promoting health equity within AI/AN communities.
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Affiliation(s)
- Maya Asami Takagi
- College of Medicine, Central Michigan University, Mount Pleasant, MI 48858, USA; (S.T.R.); (J.H.K.); (M.K.); (S.S.); (C.M.); (A.S.C.); (A.C.); (C.B.); (N.R.)
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA 95817, USA
| | - Simone T. Rhodes
- College of Medicine, Central Michigan University, Mount Pleasant, MI 48858, USA; (S.T.R.); (J.H.K.); (M.K.); (S.S.); (C.M.); (A.S.C.); (A.C.); (C.B.); (N.R.)
| | - Jun Hwan Kim
- College of Medicine, Central Michigan University, Mount Pleasant, MI 48858, USA; (S.T.R.); (J.H.K.); (M.K.); (S.S.); (C.M.); (A.S.C.); (A.C.); (C.B.); (N.R.)
| | - Maxwell King
- College of Medicine, Central Michigan University, Mount Pleasant, MI 48858, USA; (S.T.R.); (J.H.K.); (M.K.); (S.S.); (C.M.); (A.S.C.); (A.C.); (C.B.); (N.R.)
| | - Stephanie Soukar
- College of Medicine, Central Michigan University, Mount Pleasant, MI 48858, USA; (S.T.R.); (J.H.K.); (M.K.); (S.S.); (C.M.); (A.S.C.); (A.C.); (C.B.); (N.R.)
| | - Chad Martin
- College of Medicine, Central Michigan University, Mount Pleasant, MI 48858, USA; (S.T.R.); (J.H.K.); (M.K.); (S.S.); (C.M.); (A.S.C.); (A.C.); (C.B.); (N.R.)
| | - Angela Sasaki Cole
- College of Medicine, Central Michigan University, Mount Pleasant, MI 48858, USA; (S.T.R.); (J.H.K.); (M.K.); (S.S.); (C.M.); (A.S.C.); (A.C.); (C.B.); (N.R.)
| | - Arlene Chan
- College of Medicine, Central Michigan University, Mount Pleasant, MI 48858, USA; (S.T.R.); (J.H.K.); (M.K.); (S.S.); (C.M.); (A.S.C.); (A.C.); (C.B.); (N.R.)
| | - Ciara Brennan
- College of Medicine, Central Michigan University, Mount Pleasant, MI 48858, USA; (S.T.R.); (J.H.K.); (M.K.); (S.S.); (C.M.); (A.S.C.); (A.C.); (C.B.); (N.R.)
| | - Stephen Zyzanski
- Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Barry Kissoondial
- College of Medicine Affiliated Community Clinic, Central Michigan University, Mount Pleasant, MI 48858, USA;
| | - Neli Ragina
- College of Medicine, Central Michigan University, Mount Pleasant, MI 48858, USA; (S.T.R.); (J.H.K.); (M.K.); (S.S.); (C.M.); (A.S.C.); (A.C.); (C.B.); (N.R.)
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Spees LP, Jackson BE, Raveendran Y, Morris HN, Emerson MA, Baggett CD, Bell RA, Salas AI, Meernik C, Akinyemiju TF, Wheeler SB. Characterizing Cancer Burden in the American Indian Population in North Carolina. Cancer Epidemiol Biomarkers Prev 2024; 33:838-845. [PMID: 38578081 PMCID: PMC11147726 DOI: 10.1158/1055-9965.epi-24-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/27/2024] [Accepted: 04/03/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The American Indian (AI) population in North Carolina has limited access to the Indian Health Service. Consequently, cancer burden and disparities may differ from national estimates. We describe the AI cancer population and examine AI-White disparities in cancer incidence and mortality. METHODS We identified cancer cases diagnosed among adult AI and White populations between 2014 and 2018 from the North Carolina Central Cancer Registry. We estimated incidence and mortality rate ratios (IRR and MRR) by race. In addition, between the AI and White populations, we estimated the ratio of relative frequency differences [RRF, with 95% confidence limits (CL)] of clinical and sociodemographic characteristics. Finally, we evaluated the geographic distribution of incident diagnoses among AI populations. RESULTS Our analytic sample included 2,161 AI and 204,613 White individuals with cancer. Compared with the White population, the AI population was more likely to live in rural areas (48% vs. 25%; RRF, 1.89; 95% CL, 1.81-1.97) and to have Medicaid (18% vs. 7%; RRF, 2.49; 95% CL, 2.27-2.71). Among the AI population, the highest age-standardized incidence rates were female breast, followed by prostate and lung and bronchus. Liver cancer incidence was significantly higher among the AI population than White population (IRR, 1.27; 95% CL, 1.01-1.59). AI patients had higher mortality rates for prostate (MRR, 1.72; CL, 1.09-2.70), stomach (MRR, 1.82; 95% CL, 1.15-2.86), and liver (MRR, 1.70; 95% CL, 1.25-2.33) cancers compared with White patients. CONCLUSIONS To reduce prostate, stomach, and liver cancer disparities among AI populations in North Carolina, multi-modal interventions targeting risk factors and increasing screening and treatment are needed. IMPACT This study identifies cancer disparities that can inform targeted interventions to improve outcomes among AI populations in North Carolina.
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Affiliation(s)
- Lisa P Spees
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, UNC-CH, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center (LCCC), UNC-CH, Chapel Hill, North Carolina
| | - Bradford E Jackson
- Lineberger Comprehensive Cancer Center (LCCC), UNC-CH, Chapel Hill, North Carolina
| | | | - Hayley N Morris
- Lineberger Comprehensive Cancer Center (LCCC), UNC-CH, Chapel Hill, North Carolina
| | - Marc A Emerson
- Lineberger Comprehensive Cancer Center (LCCC), UNC-CH, Chapel Hill, North Carolina
- Department of Epidemiology, Gillings School of Global Public Health, UNC-CH, Chapel Hill, North Carolina
| | - Christopher D Baggett
- Lineberger Comprehensive Cancer Center (LCCC), UNC-CH, Chapel Hill, North Carolina
- Department of Epidemiology, Gillings School of Global Public Health, UNC-CH, Chapel Hill, North Carolina
| | - Ronny A Bell
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, UNC-CH, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center (LCCC), UNC-CH, Chapel Hill, North Carolina
| | - Ana I Salas
- Lineberger Comprehensive Cancer Center (LCCC), UNC-CH, Chapel Hill, North Carolina
| | - Clare Meernik
- Duke Cancer Institute (DCI), Chapel Hill, North Carolina
| | | | - Stephanie B Wheeler
- Lineberger Comprehensive Cancer Center (LCCC), UNC-CH, Chapel Hill, North Carolina
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, North Carolina
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Garcia AN, Venegas-Murrillo A, Martinez-Hollingsworth A, Smith LV, Wells K, Heilemann MV, Fischbach L, Cummings PL, Kuo T. Patterns of Health Care Access and Use in an Urban American Indian and Alaska Native Population. J Racial Ethn Health Disparities 2024; 11:1478-1488. [PMID: 37202652 PMCID: PMC10195651 DOI: 10.1007/s40615-023-01624-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/29/2023] [Accepted: 04/26/2023] [Indexed: 05/20/2023]
Abstract
Studies of health care access and use among historically resilient populations, while common, often field a limited sample size and rarely ask the groups most impacted by health inequities to weigh in. This is especially so for research and programs that focus on the American Indian and Alaska Native (AIAN) population. The present study addresses this gap by examining data from a cross-sectional survey of AIANs in Los Angeles County. To better interpret project findings and generate culturally relevant contexts, qualitative feedback was gathered at a community forum held in Spring 2018. Because recruitment of AIANs has historically been challenging, purposive sampling was employed to strategically identify a larger eligible pool. Among those who were eligible, 94% completed the survey (n = 496). AIANs who were enrolled in a tribe were 32% more likely to use the Indian Health Service (IHS), compared with those who were not enrolled (95% CI: 20.4%, 43.2%; p < .0001). In multivariable modeling, the strongest factors influencing IHS access and use were: tribal enrollment, preference for culturally-specific health care, proximity of the services to home or work, having Medicaid, and having less than a high school education. Feedback from the community forum indicated cost and trust (of a provider) were important considerations for most AIANs. Study findings reveal heterogeneous patterns of health care access and use in this population, suggesting a need to further improve the continuity, stability, and the image of AIANs' usual sources of care (e.g., IHS, community clinics).
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Affiliation(s)
- Andrea N. Garcia
- Los Angeles County Department of Mental Health, 510 S. Vermont Street, Los Angeles, CA 90020 USA
- County Department of Mental Health, National Clinician Scholars Program at the University of California, (UCLA); Los Angeles CA, Los Angeles, USA
| | - Angela Venegas-Murrillo
- National Clinician Scholars Program at UCLA, Charles R. Drew University of Medicine and Science, Los Angeles, CA USA
| | | | - Lisa V. Smith
- Rapid Assessment, Training and Evaluation Unit – Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA USA
| | - Kenneth Wells
- Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine; Department of Health Policy and Management, UCLA Fielding School of Public Health, Center for Health Services and Society of the Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA USA
| | - MarySue V. Heilemann
- UCLA School of Nursing, National Clinician Scholars Program at UCLA, Los Angeles, CA USA
| | - Lori Fischbach
- Quality Assurance Team, COVID-19 Outbreak Management Branch, Los Angeles County Department of Public Health, Los Angeles, CA USA
| | - Patricia L. Cummings
- Epidemiology Research & Evaluation, Eisenhower Medical Center, Rancho Mirage, CA USA
| | - Tony Kuo
- Department of Family Medicine, UCLA David Geffen School of Medicine; Department of Epidemiology, UCLA Fielding School of Public Health, Population Health Program, UCLA Clinical and Translational Science Institute, Los Angeles, CA USA
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Bikomeye JC, Awoyinka I, Kwarteng JL, Beyer AM, Rine S, Beyer KMM. Disparities in Cardiovascular Disease-Related Outcomes Among Cancer Survivors in the United States: A Systematic Review of the Literature. Heart Lung Circ 2024; 33:576-604. [PMID: 38184426 PMCID: PMC11144115 DOI: 10.1016/j.hlc.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Cancer and cardiovascular disease (CVD) are major causes of morbidity and mortality in the United States (US). Cancer survivors have increased risks for CVD and CVD-related mortality due to multiple factors including cancer treatment-related cardiotoxicity. Disparities are rooted in differential exposure to risk factors and social determinants of health (SDOH), including systemic racism. This review aimed to assess SDOH's role in disparities, document CVD-related disparities among US cancer survivors, and identify literature gaps for future research. METHODS Following the Peer Review of Electronic Search Strategies (PRESS) guidelines, MEDLINE, PsycINFO, and Scopus were searched on March 15, 2021, with an update conducted on September 26, 2023. Articles screening was performed using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, a pre-defined Population, Exposure, Comparison, Outcomes, and Settings (PECOS) framework, and the Rayyan platform. A modified version of the Newcastle-Ottawa Scale was used to assess the risk of bias, and RAW Graphs for alluvial charts. This review is registered with PROSPERO under ID #CRD42021236460. RESULTS Out of 7,719 retrieved articles, 24 were included, and discussed diverse SDOH that contribute to CVD-related disparities among cancer survivors. The 24 included studies had a large combined total sample size (n=7,704,645; median=19,707). While various disparities have been investigated, including rural-urban, sex, socioeconomic status, and age, a notable observation is that non-Hispanic Black cancer survivors experience disproportionately adverse CVD outcomes when compared to non-Hispanic White survivors. This underscores historical racism and discrimination against non-Hispanic Black individuals as fundamental drivers of CVD-related disparities. CONCLUSIONS Stakeholders should work to eliminate the root causes of disparities. Clinicians should increase screening for risk factors that exacerbate CVD-related disparities among cancer survivors. Researchers should prioritise the investigation of systemic factors driving disparities in cancer and CVD and develop innovative interventions to mitigate risk in cancer survivors.
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Affiliation(s)
- Jean C Bikomeye
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; PhD Program in Public and Community Health, Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Iwalola Awoyinka
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; PhD Program in Public and Community Health, Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jamila L Kwarteng
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andreas M Beyer
- Department of Medicine and Physiology, Division of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sarah Rine
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; PhD Program in Public and Community Health, Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kirsten M M Beyer
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; PhD Program in Public and Community Health, Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
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Akapo AO, Schultz C, Coelho D, Muffly TM. American Indian and Alaskan Native Access to Obstetrics and Gynecology Subspecialists: Findings From a National Mystery Caller Study in the United States. Cureus 2023; 15:e51403. [PMID: 38292990 PMCID: PMC10826858 DOI: 10.7759/cureus.51403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2023] [Indexed: 02/01/2024] Open
Abstract
Background A significant disparity exists for American Indian and Alaska Native populations in accessing obstetric and gynecology (OBGYN) subspecialty care, as nearly 43% of individuals do not reside in areas where the Indian Health Service (IHS) provides care. Geographical separation from IHS facilities exacerbates healthcare disparities, particularly regarding access to specialized services. This study aims to create a map illustrating the average driving time from an IHS clinic to OBGYN subspecialists (e.g., gynecologic oncology, maternal-fetal medicine, family planning, urogynecology, pediatric and adolescent gynecology, and reproductive endocrinology and infertility [REI]) and determine the average wait time for appointments with these specialists. Study design A cross-sectional and mystery caller study was conducted using hospital-level data from the IHS and data on women from the 2010 United States Census provided by the US Census Bureau. All US OBGYN subspecialists were identified and mapped. The local distribution of clinics near IHS hospitals was determined, and the nearest OBGYN subspecialist was mapped to IHS hospitals providing women's care services. Thirty-seven OBGYN subspecialists closest to IHS hospitals were contacted to calculate the mean wait time for subspecialty care appointments. Results The median driving time to the closest gynecologic oncology, maternal-fetal medicine, family planning, urogynecology, pediatric and adolescent gynecology, and reproductive endocrinology and infertility OBGYN subspecialist was 214 minutes (interquartile range [IQR] 107-290). The longest drive to see a subspecialist for urogynecology services was over 240 minutes. From the 2010 US Census, we identified 583,574 American Indian and Alaska Native (AI/AN) pediatric, adolescent, and women within a 60-minute drive of an IHS hospital. The mean wait time for a new patient appointment was 13.6 business days (SD ± 2). Conclusions Geographical disparities significantly impact the ability of American Indian and Alaska Native populations to access OBGYN subspecialty care. There was no difference in wait times compared to the national average, though there were significantly longer drive times.
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Affiliation(s)
- Adeola O Akapo
- Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Claire Schultz
- Obstetrics and Gynecology, Denver Health and Hospital Authority, Denver, USA
| | - Diego Coelho
- Biostatistics and Epidemiology, Coelho Services, Florianópolis, BRA
| | - Tyler M Muffly
- Obstetrics and Gynecology, Denver Health and Hospital Authority, Denver, USA
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Ponce SA, Wilkerson M, Le R, Nápoles AM, Strassle PD. Inability to get needed health care during the COVID-19 pandemic among a nationally representative, diverse population of U.S. adults with and without chronic conditions. BMC Public Health 2023; 23:1868. [PMID: 37752511 PMCID: PMC10523792 DOI: 10.1186/s12889-023-16746-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Delays in health care have been observed in the U.S. during the COVID-19 pandemic; however, the prevalence of inability to get needed care and potential disparities in health care access have yet to be assessed. METHODS We conducted a nationally representative, online survey of 5,500 American Indian/Alaska Native, Asian, Black/African American, Latino (English- and Spanish-speaking), Native Hawaiian/Pacific Islander, White, and multiracial adults between 12/2020-2/2021 (baseline) and 8/16/2021-9/9/2021 (6-month follow-up). Participants were asked "Since the start of the pandemic, was there any time when you did not get medical care that you needed?" Those who responded "Yes" were asked about the type of care and the reason for not receiving care. Poisson regression was used to estimate the association between sociodemographics and inability to receive needed care; all analyses were stratified by chronic condition status. Chronic conditions included: chronic obstructive pulmonary disease (COPD), heart conditions, type 2 diabetes, chronic kidney disease or on dialysis, sickle cell disease, cancer, and immunocompromised state (weakened immune system). RESULTS Overall, 20.0% of participants at baseline and 22.7% at follow-up reported not getting needed care. The most common reasons for being unable to get needed care included fear of COVID-19 (baseline: 44.1%; follow-up: 47.2%) and doctors canceled appointment (baseline: 25.3%; follow-up: 14.1%). Routine care (baseline: 59.9%; follow-up: 62.6%) and chronic care management (baseline: 31.5%; follow-up: 30.1%) were the most often reported types of delayed care. Fair/poor self-reported physical health was significantly associated with being unable to get needed care despite chronic condition status (≥ 1 chronic condition: aPR = 1.36, 95%CI = 1.04-1.78); no chronic conditions: aPR = 1.52, 95% CI = 1.28-1.80). The likelihood of inability to get needed care differed in some instances by race/ethnicity, age, and insurance status. For example, uninsured adults were more likely to not get needed care (≥ 1 chronic condition: aPR = 1.76, 95%CI = 1.17-2.66); no chronic conditions: aPR = 1.25, 95% CI = 1.00-1.56). CONCLUSIONS Overall, about one fifth of participants reported being unable to receive needed care at baseline and follow-up. Delays in receiving needed medical care may exacerbate existing conditions and perpetuate existing health disparities among vulnerable populations who were more likely to have not received needed health care during the pandemic.
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Affiliation(s)
- Stephanie A Ponce
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Miciah Wilkerson
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Randy Le
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Anna María Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Paula D Strassle
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.
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Blue B, Pierre A, Mikhael J. Culturally Responsive Care Delivery in Oncology: The Example of Multiple Myeloma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:651-659. [PMID: 37290997 DOI: 10.1016/j.clml.2023.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 06/10/2023]
Abstract
Multiple myeloma (MM) represents ∼1% of all cancers and is the second most common hematologic malignancy worldwide. The incidence of MM is at least two times higher in Blacks/African Americans compared with their White counterparts, and Hispanics/Latinxs are among the youngest patients diagnosed with the disease. Recent advances in available treatments for MM have demonstrated significant improvement in survival outcomes; however, patients from non-White racial/ethnic groups clinically benefit less due to multiple factors including access to care, socioeconomic status, medical mistrust, underutilization of novel therapies, and exclusion from clinical trials. Health inequities in disease characteristics and risk factors based on race also contribute to inequities in outcomes. In this review, we highlight racial/ethnic factors as well as structural barriers attributed to variations in MM epidemiology and management. We focus on three populations-Black/African American, Hispanic/Latinx, and American Indian/Alaska Native-and review factors that healthcare professionals may consider when treating patients of color. We offer tangible advice for healthcare professionals on how to incorporate cultural humility into their practice by following the five key steps: establishing trust, respecting cultural diversity, undergoing cross-cultural training, counseling patients on appropriate available clinical trial options, and connecting patients to community resources. The outlined recommendations will help the medical community to better understand and apply the important concept of cultural humility into their practice to provide the best care for all their patients, regardless of race/ethnicity.
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Affiliation(s)
- Brandon Blue
- H. Lee Moffitt Cancer Center and Research Institute, Department of Malignant Hematology, Tampa, FL.
| | - Amy Pierre
- Memorial Sloan Kettering Cancer Center, Division of Multiple Myeloma and Lymphoma, Montvale, NJ; Flatiron Health, Division of Research Oncology and Real World Evidence, New York, NY
| | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, AZ; International Myeloma Foundation, Chief Medical Officer, Studio City, CA
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Pomerville A, Wilbur RE, Pham TV, King CA, Gone JP. Behavioral health services in Urban American Indian Health Programs: Results from six site visits. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:2618-2634. [PMID: 36976752 DOI: 10.1002/jcop.23035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
This study explores behavioral health services for American Indians and Alaska Natives (AIANs) at six Urban Indian Health Programs (UIHPs). Interviews and focus groups with clinicians and staff inquired about behavioral health treatment available, service needs, client population, and financial and staffing challenges. Resulting site profiles were created based on focused coding and integrative memoing of site visit field notes and respondent transcripts. These six UIHPs evidenced diversity across multiple facets of service delivery even as they were united in their missions to provide accessible and effective behavioral health treatment to urban AIAN clients. Primary challenges to service provision included heterogenous client populations, low insurance coverage, limited provider knowledge, lack of resources, and incorporation of traditional healing. Collaborative research with UIHPs harbors the potential to recognize challenges, identify solutions, and share best practices across this crucial network of health care sites for improving urban AIAN well-being.
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Affiliation(s)
- Andrew Pomerville
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rachel E Wilbur
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Tony V Pham
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Cheryl A King
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Joseph P Gone
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Anthropology, Harvard University, Cambridge, Massachusetts, USA
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Christensen EW, Pelzl CE, Patel BK, Carlos RC, Rula EY. Urbanicity, Income, and Mammography-Use Disparities Among American Indian Women. Am J Prev Med 2023; 64:611-620. [PMID: 37085244 DOI: 10.1016/j.amepre.2023.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Reported breast cancer screening among American Indian women is consistently below that of White women. The last claims-based trends were from 1991 to 2001. This study updates mammography trends for American Indian women and examines the impact of race, urbanicity, and income on long-term mammography use. METHODS This was a multi-year (2005-2019), retrospective study of women aged 40-89 years using a 5% sample of Medicare fee-for-service beneficiaries residing in Arizona, California, New Mexico, Oklahoma, and Washington. This study used multivariable logistic regression to examine the impact of urbanicity and income on receiving mammography for American Indian women compared with that for White women. Analyses were conducted in 2022. RESULTS Overall, annual age-adjusted mammography use declined from 205 per 1,000 in 2005 to 165 per 1,000 in 2019. The slope of these declines was significantly steeper (difference = -2.41, p<0.001) for White women (-3.06) than for American Indian women (-0.65). Mammography-use odds across all urbanicity categories were less for American Indian women than for White women compared with those of their respective metropolitan counterparts (e.g., rural: 0.96, 95% CI=0.77, 1.20 for American Indian women and 1.47, 99% CI=1.39, 1.57 for White women). Although residing in higher-income communities was not associated with mammography use for American Indian women, it was 31% higher for White women (OR=1.31, 99% CI=1.28, 1.34). CONCLUSIONS The disparity in annual age-adjusted mammography use between American Indian and White women narrowed between 2005 and 2019. However, the association of urbanicity and community income on mammography use differs substantially between American Indian and White women. Policies to reduce disparities need to consider these differences.
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Affiliation(s)
- Eric W Christensen
- Harvey L. Neiman Health Policy Institute, Reston, Virginia; Health Services Management, University of Minnesota, St Paul, Minesota.
| | - Casey E Pelzl
- Harvey L. Neiman Health Policy Institute, Reston, Virginia
| | - Bhavika K Patel
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Ruth C Carlos
- Division of Abdominal Radiology, University of Michigan, Ann Arbor, Michigan
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Serchen J, Mathew S, Hilden D, Southworth M, Atiq O. Supporting the Health and Well-Being of Indigenous Communities: A Position Paper From the American College of Physicians. Ann Intern Med 2022; 175:1594-1597. [PMID: 36215716 DOI: 10.7326/m22-1891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Indigenous peoples in the United States experience many health disparities and barriers to accessing health care services. In addition, Indigenous communities experience poor social drivers of health, including disproportionately high rates of food insecurity, violence, and poverty, among others. These challenges are unsurprising, given historical societal discrimination toward Indigenous peoples and government policies of violence, forced relocation with loss of ancestral home, and erasure of cultures and traditions. Indigenous peoples have displayed resilience that has sustained their communities through these hardships. Through treaties between the federal government and Indigenous nations, the federal government has assumed a trust responsibility to provide for the health and well-being of Indigenous populations through the direct provision of health care services and financial support of tribally operated health systems. However, despite serving a population that has endured substantial historical trauma and subsequent health issues, federal programs serving Indigenous peoples receive inadequate federal funding and substantially fewer resources compared with other federal health care programs. Access to care is further challenged by geographic isolation and health care workforce vacancies. Given the history of Indigenous peoples in the United States and their treatment by the federal government and society, the American College of Physicians (ACP) asserts the federal government must faithfully execute its trust responsibility through increased funding and resources directed toward Indigenous communities and the undertaking of concerted policy efforts to support the health and well-being of Indigenous people. ACP believes that these efforts must be community-driven, Indigenous-led, and culturally appropriate and accepted, and center values of respect and self-determination.
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Affiliation(s)
- Josh Serchen
- American College of Physicians, Washington, DC (J.S.)
| | - Suja Mathew
- Atlantic Health System, Morristown, New Jersey (S.M.)
| | - David Hilden
- Hennepin Healthcare, Minneapolis, Minnesota (D.H.)
| | - Molly Southworth
- WWAMI School of Medical Education, University of Alaska Anchorage, Anchorage, Alaska (M.S.)
| | - Omar Atiq
- University of Arkansas for Medical Sciences, Little Rock, Arkansas (O.A.)
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Solomon SD, Shoge RY, Ervin AM, Contreras M, Harewood J, Aguwa UT, Olivier MMG. Improving Access to Eye Care: A Systematic Review of the Literature. Ophthalmology 2022; 129:e114-e126. [PMID: 36058739 DOI: 10.1016/j.ophtha.2022.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 01/02/2023] Open
Abstract
PURPOSE The goals were to develop a working and inclusive definition of access to eye care, identify gaps in the current system that preclude access, and highlight recommendations that have been identified in prior studies. This manuscript serves as a narrative summary of the literature. CLINICAL RELEVANCE Health care disparities continue to plague the nation's well-being, and eye care is no exception. Inequities in eye care negatively affect disease processes (i.e., glaucoma, cataracts, diabetic retinopathy), interventions (surgical treatment, prescription of glasses, referrals), and populations (gender, race and ethnicity, geography, age). METHODS A systematic review of the existing literature included all study designs, editorials, and opinion pieces and initially yielded nearly 2500 reports. To be included in full-text review, an article had to be US-based, be written in English, and address 1 or more of the key terms "barriers and facilitators to health care," "access," and "disparities in general and sub-specialty eye care." Both patient and health care professional perspectives were included. One hundred ninety-six reports met the inclusion criteria. RESULTS Four key themes regarding access to eye care from both patient and eye care professional perspectives emerged in the literature: (1) barriers and facilitators to access, (2) utilization, (3) compliance and adherence, and (4) recommendations to improve access. Common barriers and facilitators included many factors identified as social determinants of health (i.e., transportation, insurance, language, education). Utilization of eye care was largely attributable to having coverage for eye care, recommendations from primary care professionals, and improved health status. Geographic proximity, age, and lack of transportation surfaced as factors for compliance and adherence. There were a variety of recommendations to improve access to eye care, including improving presence in community health clinics, reimbursement for physicians, and funding of community-based programs such as DRIVE and REACH. CONCLUSIONS The eye care profession has abundant evidence of the disparities that continue to affect marginalized communities. Improving community-based programs and clinics, addressing social determinants of health, and acknowledging the effects of discrimination and bias on eye care serve as ways to improve equity in this field.
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Affiliation(s)
- Sharon D Solomon
- School of Medicine, Johns Hopkins University, Baltimore, Maryland.
| | - Ruth Y Shoge
- School of Optometry, University of California Berkeley, Berkeley, California
| | - Ann Margret Ervin
- School of Medicine, Johns Hopkins University, Baltimore, Maryland; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Melissa Contreras
- College of Optometry, Marshall B. Ketchum University, Fullerton, California
| | | | - Ugochi T Aguwa
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Mildred M G Olivier
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, Illinois
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Ottesen TD, Amick M, Kapadia A, Ziatyk EQ, Joe JR, Sequist TD, Agarwal-Harding KJ. The Unmet Need for Orthopaedic Services Among American Indian and Alaska Native Communities in the United States. J Bone Joint Surg Am 2022; 104:e47. [PMID: 35104253 DOI: 10.2106/jbjs.21.00512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
ABSTRACT Historic and present-day marginalization has resulted in a high burden of disease and worse health outcomes for American Indian and Alaska Native (AI/AN) communities in the United States. Musculoskeletal disease is the leading cause of disability for the general population in the U.S. today. However, few have examined musculoskeletal disease burden and access to orthopaedic surgical care in the AI/AN communities. A high prevalence of hip dysplasia, arthritis, back pain, and diabetes, and a high incidence of trauma and road traffic-related mortality, suggest a disproportionately high burden of musculoskeletal pathology among the AI/AN communities and a substantial need for orthopaedic surgical services. Unfortunately, AI/AN patients face many barriers to receiving specialty care, including long travel distances and limited transportation to health facilities, inadequate staff and resources at Indian Health Service (IHS)-funded facilities, insufficient funding for referral to specialists outside of the IHS network, and sociocultural barriers that complicate health-system navigation and erode trust between patients and providers. For those who manage to access orthopaedic surgery, AI/AN patients face worse outcomes and more complications than White patients. There is an urgent need for orthopaedic surgeons to participate in improving the availability of quality orthopaedic services for AI/AN patients through training and support of local providers, volunteerism, advocating for a greater investment in the IHS Purchased/Referred Care program, expanding telemedicine capabilities, and supporting community-based participatory research activities.
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Affiliation(s)
- Taylor D Ottesen
- Harvard Global Orthopaedics Collaborative, Boston, Massachusetts
- Massachusetts General Hospital/Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts
| | - Michael Amick
- Harvard Global Orthopaedics Collaborative, Boston, Massachusetts
- Yale University School of Medicine, New Haven, Connecticut
| | - Ami Kapadia
- Harvard Global Orthopaedics Collaborative, Boston, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elizabeth Q Ziatyk
- Department of Family Medicine, Chinle Comprehensive Healthcare Facility, Chinle, Arizona
| | - Jennie R Joe
- Department of Family and Community Medicine, University of Arizona Health Sciences, Tucson, Arizona
- Native American Research and Training Center, University of Arizona Health Sciences, Tucson, Arizona
| | - Thomas D Sequist
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Healthcare Policy, Harvard Medical School, Boston, Massachusetts
| | - Kiran J Agarwal-Harding
- Harvard Global Orthopaedics Collaborative, Boston, Massachusetts
- Department of Orthopaedic Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
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Kruse G, Lopez-Carmen VA, Jensen A, Hardie L, Sequist TD. The Indian Health Service and American Indian/Alaska Native Health Outcomes. Annu Rev Public Health 2022; 43:559-576. [PMID: 35081315 DOI: 10.1146/annurev-publhealth-052620-103633] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Indian Health Service (IHS) has made huge strides in narrowing health disparities between American Indian and Alaska Native (AI/AN) populations and other racial and ethnic groups. Yet, health disparities experienced by AI/AN people persist, with deep historical roots combined with present-day challenges. Here we review the history of the IHS from colonization to the present-day system, highlight persistent disparities in AI/AN health and health care, and discuss six key present-day challenges: inadequate funding, limited human resources, challenges associated with transitioning services from federal to Tribal control through contracting and compacting, evolving federal and state programs, the need for culturally sensitive services, and the promise and challenges of health technology.
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Affiliation(s)
- Gina Kruse
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA;
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Anpotowin Jensen
- School of Engineering, Stanford University, Stanford, California, USA
| | - Lakotah Hardie
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA;
| | - Thomas D Sequist
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Quality and Patient Experience, Massachusetts General Brigham, Somerville, Massachusetts, USA
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Woodward MA, Hughes K, Ballouz D, Hirth RA, Errickson J, Newman-Casey PA. Assessing Eye Health and Eye Care Needs Among North American Native Individuals. JAMA Ophthalmol 2022; 140:134-142. [PMID: 34940785 PMCID: PMC8855236 DOI: 10.1001/jamaophthalmol.2021.5507] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IMPORTANCE There are few population-level studies on ophthalmic conditions and services among North American Native individuals. OBJECTIVE To evaluate whether disparities in ophthalmic conditions and services exist between North American Native individuals and non-Hispanic White individuals in the US. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used 100% Medicare fee-for-service (MFFS) enrollment data from the Vision and Eye Health Surveillance System (VEHSS) to examine ophthalmic conditions and service use in North American Native individuals and non-Hispanic White individuals in the US. In this study North American Native individuals included those who identified as American Indian, Native Alaskan, Native Hawaiian, and Pacific Islander. Data were analyzed from August 2020 to April 2021. INTERVENTIONS Claims and sociodemographic characteristics were extracted and means computed for categories of ophthalmic conditions and select ophthalmic services. Ophthalmic conditions and services were defined in the VEHSS using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Logistic regression was used to model differences between age-adjusted mean ophthalmic condition and service claim rates among North American Native individuals and non-Hispanic White individuals for each age cohort. Matching ophthalmic condition claim rates and ophthalmic service claim rates was performed to examine disparities by racial group. MAIN OUTCOMES AND MEASURES Mean age-adjusted claim rates for ophthalmic conditions and services among North American Native individuals vs non-Hispanic White individuals per 100 persons. RESULTS Claims were identified for 177 100 Native American Native individuals and 24 438 000 non-Hispanic White individuals. In 16 of 17 ophthalmic condition categories and 6 of 9 service categories, North American Native individuals had significantly different claim rates from non-Hispanic White individuals. There were higher ophthalmic condition claim rates but lower service claim rates for North American Native individuals (vs non-Hispanic White individuals) for refractive errors (ophthalmic condition, 17.2 vs 11.1; service, 48.3 vs 49.6, respectively; P < .001); blindness and low vision (ophthalmic condition, 1.48 vs 0.75: service, 19.2 vs 20.1, respectively; P < .001); injury, burns, and surgical complications (ophthalmic condition, 1.8 vs 1.7; service, 19.2 vs 20.1, respectively; P < .001); and orbital and external disease (ophthalmic condition, 15.7 vs 13.3; service, 48.3 vs 49.6, respectively; P < .001). For diabetic eye diseases, North American Native individuals had higher ophthalmic condition claim rates (5.22 vs 2.20) but no difference in service claim rates (14.4 vs 14.8; P = .26) compared with non-Hispanic White individuals. CONCLUSIONS AND RELEVANCE In this cross-sectional study, North American Native individuals had higher prevalence of ophthalmic conditions but no corresponding increase in services (treatment for most ophthalmic conditions) compared with non-Hispanic White individuals. These results suggest worse eye health and higher unmet eyecare needs for North American Native individuals with MFFS coverage compared with non-Hispanic White individuals with MFFS coverage.
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Affiliation(s)
- Maria A. Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | | | - Dena Ballouz
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - Richard A. Hirth
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor,Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
| | - Josh Errickson
- Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
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Awareness of Diabetic Retinopathy: Insight From the National Health and Nutrition Examination Survey. Am J Prev Med 2021; 61:900-909. [PMID: 34426057 PMCID: PMC8608699 DOI: 10.1016/j.amepre.2021.05.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION This study determines the prevalence and associated correlates of people unaware of their diabetic retinopathy diagnosis in the U.S. METHODS Participants unaware of diabetic retinopathy from the National Health and Nutrition Examination Survey from 2005 to 2008 were identified. The prevalence of those unaware of their diabetic retinopathy diagnosis was determined. Descriptive statistics and logistic regression were used to determine correlates associated with being unaware of one's diabetic retinopathy diagnosis (completed in 2018‒2020). RESULTS Among 5,563 participants aged ≥40 years who underwent fundus photography, the prevalence of those unaware of their diabetic retinopathy diagnosis was 10.6% (9.8 million). This included 23.1% of those with self-reported diabetes (2.9 million) and 6.8% of those who reported not having diabetes (6.9 million). Among participants reporting diabetes with photographic evidence of retinopathy, 70.1% were unaware. Among individuals with self-reported diabetes, correlates of being unaware of one's diabetic retinopathy diagnosis included diabetes diaganosis for ≥10 years (OR=3.15, 95% CI=1.78, 5.56), HbA1c ≥6.5% (OR=2.92, 95% CI=1.65, 5.18), and treatment with insulin only (OR=4.04, 95% CI=1.43, 11.39). Self-reported hypertension was associated with decreased odds of undiagnosed diabetic retinopathy (OR=0.48, 95% CI=0.28, 0.82). Among those without self-reported diabetes, correlates of being unaware of diabetic retinopathy included older age (OR=1.02, 95% CI=1.01, 1.04), male sex (OR=1.83, 95% CI=1.31, 2.56), Black race (OR=1.81, 95% CI=1.12, 2.92), Hispanic race/ethnicity (OR=1.60, 95% CI=1.14, 2.25), elevated blood pressure (OR=1.54, 95% CI=1.23, 1.93), current smoking (OR=1.74, 95% CI=1.21, 2.51), and history of stroke (OR=2.20, 95% CI=1.06, 4.58). CONCLUSIONS A substantial proportion of individuals with diabetic retinopathy are unaware of the diagnosis. These data provide a path toward refining efforts to diagnose and treat diabetic retinopathy to decrease the burden of preventable blindness.
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Affiliation(s)
- Thomas D Sequist
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Hiraldo D, James K, Carroll SR. Case Report: Indigenous Sovereignty in a Pandemic: Tribal Codes in the United States as Preparedness. FRONTIERS IN SOCIOLOGY 2021; 6:617995. [PMID: 33869571 PMCID: PMC8022763 DOI: 10.3389/fsoc.2021.617995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/19/2021] [Indexed: 05/07/2023]
Abstract
Indigenous Peoples globally and in the United States have combatted and continue to face disease, genocide, and erasure, often the systemic result of settler colonial policies that seek to eradicate Indigenous communities. Many Native nations in the United States have asserted their inherent sovereign authority to protect their citizens by passing tribal public health and emergency codes to support their public health infrastructures. While the current COVID-19 pandemic affects everyone, marginalized and Indigenous communities in the United States experience disproportionate burdens of COVID-19 morbidity and mortality as well as socioeconomic and environmental impacts. In this brief research report, we examine 41 publicly available tribal public health and emergency preparedness codes to gain a better understanding of the institutional public health capacity that exists during this time. Of the codes collected, only nine mention any data sharing provisions with local, state, and federal officials while 21 reference communicable diseases. The existence of these public health institutions is not directly tied to the outcomes in the current pandemic; however, it is plausible that having such codes in place makes responding to public health crises now and in the future less reactionary and more proactive in meeting community needs. These tribal institutions advance the public health outcomes that we all want to see in our communities.
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Affiliation(s)
- Danielle Hiraldo
- Native Nations Institute, University of Arizona, Tucson, AZ, United States
| | - Kyra James
- Native Nations Institute, University of Arizona, Tucson, AZ, United States
| | - Stephanie Russo Carroll
- Native Nations Institute, University of Arizona, Tucson, AZ, United States
- College of Public Health, University of Arizona, Tucson, AZ, United States
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Findling MTG, Blendon RJ, Benson JM, Miller C. The Unseen Picture: Issues with Health Care, Discrimination, Police and Safety, and Housing Experienced by Native American Populations in Rural America. J Rural Health 2020; 38:180-186. [PMID: 33022083 PMCID: PMC9290671 DOI: 10.1111/jrh.12517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Purpose Despite increased national attention to improving rural health, rural Native American populations face unique problems that are often unseen in aggregate research on the rural United States. The objective of this study was to examine rural Native Americans’ experiences with serious problems across domains important to health, using rural Whites as a comparison group. Methods Using 2 probability‐based national telephone surveys (2017 and 2019), we examined rural Native American adults’ reported problems in health care, discrimination, police and safety, and housing. We then compared Native American‐White differences in reported problems across domains. Findings Among rural Native American adults, 33% reported recent problems accessing health care when they needed it, 28% reported they or family members recently experienced major problems paying for medical bills, and 28% reported recent problems with health care quality. Several Native American‐White differences were reported, including experiencing racial violence (34% vs 5%, P < .001), discrimination in health care (19% vs 3%, P = .003), unfair police treatment (27% vs 5%, P = .002), and major housing problems (48% vs 26%, P < .001). Conclusions Rural Native American adults report ongoing and widespread problems with health care, discrimination, the police, safety, and housing. These findings support many national policy recommendations to improve federal funding and oversight for programs serving Native American populations living in rural areas.
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Affiliation(s)
- Mary T G Findling
- Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Robert J Blendon
- Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - John M Benson
- Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Carolyn Miller
- Research, Evaluation, and Learning Unit, Robert Wood Johnson Foundation, Princeton, New Jersey
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Meltzer GY, Watkins BX, Vieira D, Zelikoff JT, Boden-Albala B. A Systematic Review of Environmental Health Outcomes in Selected American Indian and Alaska Native Populations. J Racial Ethn Health Disparities 2020; 7:698-739. [PMID: 31974734 DOI: 10.1007/s40615-020-00700-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/30/2019] [Accepted: 01/06/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Economic and social marginalization among American Indians and Alaska Natives (AI/ANs) results in higher chronic disease prevalence. Potential causal associations between toxic environmental exposures and adverse health outcomes within AI/AN communities are not well understood. OBJECTIVES This review examines epidemiological literature on exposure to toxicants and associated adverse health outcomes among AI/AN populations. METHODS PubMed, Embase, Cochrane, Environment Complete, Web of Science Plus, DART, and ToxLine were searched for English-language articles. The following data were extracted: lead author's last name, publication year, cohort name, study location, AI/AN tribe, study initiation and conclusion, sample size, primary characteristic, environmental exposure, health outcomes, risk estimates, and covariates. RESULTS About 31 articles on three types of environmental exposures met inclusion criteria: persistent organic pollutants (POPs), heavy metals, and open dumpsites. Of these, 17 addressed exposure to POPs, 10 heavy metal exposure, 2 exposure to both POPs and heavy metals, and 2 exposure to open dumpsites. Studies on the Mohawk Nation at Akwesasne; Yupik on St. Lawrence Island, Alaska; Navajo Nation; Gila River Indian Community; Cheyenne River Sioux; 197 Alaska Native villages; and 13 tribes in Arizona, Oklahoma, North Dakota, and South Dakota that participated in the Strong Heart Study support associations between toxicant exposure and various chronic conditions including cardiovascular conditions, reproductive abnormalities, cancer, autoimmune disorders, neurological deficits, and diabetes. DISCUSSION The complex interplay of environmental and social factors in disease etiology among AI/ANs is a product of externally imposed environmental exposures, systemic discrimination, and modifiable risk behaviors. The connection between environmental health disparities and adverse health outcomes indicates a need for further study.
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Affiliation(s)
- Gabriella Y Meltzer
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, 715/719 Broadway, New York, NY, 10003, USA.
| | - Beverly-Xaviera Watkins
- Department of Epidemiology, New York University School of Global Public Health, 715/719 Broadway, New York, NY, 10003, USA
| | - Dorice Vieira
- Health Sciences Library, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Judith T Zelikoff
- Department of Environmental Medicine, New York University School of Medicine, 341 East 25th Street, New York, NY, 10010, USA
| | - Bernadette Boden-Albala
- Department of Population Health, University of California Irvine, 653 East Peltason Drive, Irvine, CA, 92697, USA
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Al-Sumaih I, Nguyen N, Donnelly M, Johnston B, Khorgami Z, O'Neill C. Ethnic Disparities in Use of Bariatric Surgery in the USA: the Experience of Native Americans. Obes Surg 2020; 30:2612-2619. [PMID: 32189129 PMCID: PMC7260278 DOI: 10.1007/s11695-020-04529-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Purpose To examine disparities in use of bariatric surgery in the USA with particular focus on the experience of Native Americans. Materials and Methods Multivariable logistic regression models were applied to the hospital discharge HCUP-NIS dataset (2008–2016) in order to examine the influence of ethnicity in use of bariatric surgery while controlling for aspects of need, predisposing and enabling factors. Separate models investigated disparities in length of stay, cost and discharge to healthcare facility among patient episodes for bariatric surgery. Results Full data for 1,729,245 bariatric surgery eligible participants were extracted from HCUP-NIS. The odds of Native Americans receiving bariatric surgery compared to White Americans were 0.67 (95% CI, 0.62–0.73) in a model unadjusted for covariates; 0.65 (95% CI, 0.59–0.71) in a model adjusted for demography and insurance; 0.59 (95% CI, 0.54–0.64) in a model adjusted for clinical variables; and 0.72 (95% CI, 0.66–0.79) in a model adjusted for demographic, insurance types and clinical variables. Native Americans who underwent surgery had significantly shorter lengths of stay, lower healthcare expenditures and lower likelihood of discharge to other healthcare facilities relative to White Americans (controlling for covariates). Conclusion Our study, the first study to examine this subject, showed apparent variations in receipt of bariatric surgery between Native Americans and White Americans even after a range of covariates were controlled. In addition, Native Americans have shorter lengths of stay and significantly lower expenditures. Electronic supplementary material The online version of this article (10.1007/s11695-020-04529-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ibrahim Al-Sumaih
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Sciences, Queen's University Belfast, Block B, Royal Victoria Hospital, Belfast, BT12 6BA, UK
- Ministry of Health, Riyadh, Saudi Arabia
| | - Nga Nguyen
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Sciences, Queen's University Belfast, Block B, Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - Michael Donnelly
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Sciences, Queen's University Belfast, Block B, Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - Brian Johnston
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Sciences, Queen's University Belfast, Block B, Royal Victoria Hospital, Belfast, BT12 6BA, UK
- Belfast Health and Social Care Trust, Belfast, UK
| | - Zhamak Khorgami
- Department of Surgery, College of Medicine, University of Oklahoma, Tulsa, OK, USA
- Harold Hamm Diabetes Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ciaran O'Neill
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Sciences, Queen's University Belfast, Block B, Royal Victoria Hospital, Belfast, BT12 6BA, UK.
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Mitton JA, Jackson S, Ho JJ, Tobey M. Opioid and Amphetamine Treatment Trends Among American Indians in the Great Plains. J Addict Med 2019; 14:e100-e102. [PMID: 31725427 DOI: 10.1097/adm.0000000000000594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Traditionally underserved populations in the United States, particularly rural and American Indian/Alaska Native (AI/AN) communities, are disproportionately impacted by the opioid and amphetamine epidemics and have a higher risk for substance use disorders. AI/AN communities in the American Great Plains face exceptional health risks. We aim to describe recent trends in opioid and amphetamine treatment admissions for AI/ANs living in the Great Plains relative to that of the general population. METHODS We used data from the 2014 to 2016 Substance Abuse and Mental Health Services Administration (SAMHSA) Drug and Alcohol Services Information System (DASIS) Treatment Episode Data Set (TEDS) for Admissions. We extracted opioid and amphetamine treatment admissions for self-identified AI/AN and non-AI/AN patients living in the Great Plains: North Dakota, South Dakota, Nebraska, and Iowa. Average annual admission rates were calculated and compared from 2014 to 2016 for AI/AN versus non-AI/AN populations. RESULTS While opioid and amphetamine treatment admissions from 2014 to 2016 increased in both AI/AN (49 vs 80 per 10,000) and non-AI/AN (20 vs 26 per 10,000) populations, the rate of increase was significantly greater among AI/ANs (64% vs 32%; P < 0. 01). These trends are largely reflective of increased amphetamine use treatment admissions observed in both AI/AN and non-AI/AN populations. CONCLUSIONS Treatment admissions for opioid and amphetamine use have increased from 2014 to 2016 for both AI/AN and non-AI/AN individuals in the Great Plains, driven largely by amphetamine use. AI/AN individuals were observed to seek care at a much higher rate. This increase in treatment admissions suggests increasing demand for services, which, in turn, necessitates greater investment of resources into AI/AN health facilities to address opioid and amphetamine use disorder in this underserved population.
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Affiliation(s)
- Julian A Mitton
- Massachusetts General Hospital Division of General Internal Medicine, Rural Health Program, Boston, MA (JAM, JJH, MT); Harvard Medical School, Boston, MA (JAM, JJH, MT); Great Plains Tribal Chairman's Health Board, Rapid City, SD (SJ)
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Cromer KJ, Wofford L, Wyant DK. Barriers to Healthcare Access Facing American Indian and Alaska Natives in Rural America. J Community Health Nurs 2019; 36:165-187. [PMID: 31621433 DOI: 10.1080/07370016.2019.1665320] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We provide a literature review concerning healthcare access for Native Americans in rural areas. We group previous research around three themes; barriers in rural America; barriers within the Indian Health Services system (including provider recruitment and retention); and the scale of services offered. Considering a wide range of access measures, a general failure exists in providing Native Americans with services comparable to those received by other Americans There are repeated findings of disparities in specific resources available, such as staff and infrastructure. Improvement appears possible through increased funding, and by giving greater management control to each tribe.
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Affiliation(s)
- Kerry J Cromer
- Gordon E. Inman College of Health Sciences & Nursing, Belmont University , Nashville , USA
| | - Linda Wofford
- Gordon E. Inman College of Health Sciences & Nursing, Belmont University , Nashville , USA
| | - David K Wyant
- Jack Massey College of Business, Belmont University , Nashville , USA
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Cullen T, Flowers J, Sequist TD, Hays H, Biondich P, Laing MZ. Envisioning health equity for American Indian/Alaska Natives: a unique HIT opportunity. J Am Med Inform Assoc 2019; 26:891-894. [PMID: 31329880 PMCID: PMC6696492 DOI: 10.1093/jamia/ocz052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/07/2019] [Accepted: 04/05/2019] [Indexed: 11/12/2022] Open
Abstract
The Indian Health Service provides care to remote and under-resourced communities in the United States. American Indian/Alaska Native patients have some of the highest morbidity and mortality among any ethnic group in the United States. Starting in the 1980s, the IHS implemented the Resource and Patient Management System health information technology (HIT) platform to improve efficiency and quality to address these disparities. The IHS is currently assessing the Resource and Patient Management System to ensure that changing health information needs are met. HIT assessments have traditionally focused on cost, reimbursement opportunities, infrastructure, required or desired functionality, and the ability to meet provider needs. Little information exists on frameworks that assess HIT legacy systems to determine solutions for an integrated rural healthcare system whose end goal is health equity. This search for a next-generation HIT solution for a historically underserved population presents a unique opportunity to envision and redefine HIT that supports health equity as its core mission.
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Affiliation(s)
- Theresa Cullen
- Center for Biomedical Informatics, Regenstrief Institute, Inc, Indianapolis, Indiana, USA
| | - Jan Flowers
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Thomas D Sequist
- Division of General Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Howard Hays
- Center for Biomedical Informatics, Regenstrief Institute, Inc, Indianapolis, Indiana, USA
| | - Paul Biondich
- Global Health Informatics, Center for Biomedical Informatics, Regenstrief Institute, Inc, Indianapolis, Indiana, USA
| | - Maia Z Laing
- Office of the Chief Technology Officer, U.S. Department of Health and Human Services, Washington, DC, USA
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Kohn LL, Introcaso CE. A Cultural Context for Providing Dermatologic Care to American Indian and Alaskan Native Communities Through Telehealth. JAMA Dermatol 2019; 155:884-886. [PMID: 31215957 DOI: 10.1001/jamadermatol.2019.0860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Lucinda L Kohn
- Department of Dermatology, University of California, San Francisco
| | - Camille E Introcaso
- Pennsylvania Center for Dermatology, a subsidiary of Schweiger Dermatology Group, Philadelphia
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Morenz AM, Wescott S, Mostaghimi A, Sequist TD, Tobey M. Evaluation of Barriers to Telehealth Programs and Dermatological Care for American Indian Individuals in Rural Communities. JAMA Dermatol 2019; 155:899-905. [PMID: 31215975 DOI: 10.1001/jamadermatol.2019.0872] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Understanding geographic and financial barriers to health care is an important step toward creating more accessible health care systems. Yet, the barriers to dermatological care access for American Indian populations in rural areas have not been studied extensively. Objective To evaluate the driving distances and insurance coverage for dermatological care and the current availability of teledermatological programs within the Indian Health Service (IHS) or tribal hospitals system. Design, Setting, and Participants This mixed-methods study was conducted from May 7, 2018, to September 1, 2018, and did not take place in any IHS or tribal health care facility in the continental United States. The study design involved a geographic analysis and a cross-sectional telephone survey with brick-and-mortar dermatology clinics (n = 27) and teledermatological programs (n = 49). Brick-and-mortar clinics were selected for their proximity to a rural IHS or tribal hospital. Main Outcomes and Measures Mean driving distance from rural IHS or tribal hospital to nearest dermatology clinic, number of dermatology clinics within a 35-mile or 90-mile radius of IHS or tribal hospitals, insurance and referral types accepted by dermatology clinics, and number of teledermatological programs collaborating with IHS or tribal hospitals or health centers. Results In total, 27 brick-and-mortar dermatology clinics and 49 teledermatological programs were identified and contacted for the survey. The median (interquartile range [IQR]) driving distance between rural IHS or tribal hospitals and the nearest dermatology clinic was 68 (30-104) miles. Of the 27 dermatology clinics in closest proximity to rural IHS or tribal hospitals (median [IQR] driving distance, 82.4 [31-114] miles), 25 (93%) responded to the survey, 6 (22%) did not accept patients with Medicaid, and 6 (22%) did not accept IHS referrals for patients without insurance. Of the 49 teledermatological programs, 45 (92%) responded and 14 (29%) were no longer active. Ten (20%) teledermatology programs were currently partnering (n = 6), previously partnered (n = 2), or were setting up services (n = 2) with an IHS or tribal site. Only 9% (n = 27) of the 303 rural IHS or facility in the continental United States reported receiving teledermatological services. Conclusions and Relevance Substantial geographic and insurance coverage barriers to dermatological care exist for American Indian individuals in rural communities; teledermatological innovations could represent an important step toward minimizing the disparities in dermatological care access and outcomes.
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Affiliation(s)
| | - Siobhan Wescott
- Indians Into Medicine Program, University of North Dakota, Grand Forks
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Thomas D Sequist
- Division of General Internal Medicine and Department of Health Care Policy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matthew Tobey
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
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DallaPiazza M, Padilla-Register M, Dwarakanath M, Obamedo E, Hill J, Soto-Greene ML. Exploring Racism and Health: An Intensive Interactive Session for Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2018; 14:10783. [PMID: 30800983 PMCID: PMC6354798 DOI: 10.15766/mep_2374-8265.10783] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 11/10/2018] [Indexed: 05/14/2023]
Abstract
Introduction Growing recognition of the deleterious effects of racism on health has led to calls for increased education on racism for health care professionals. As part of a larger curriculum on health equity and social justice, we developed a new educational session on racism for first-year medical students consisting of a lecture followed by a case-based small-group discussion. Methods Over the academic years of 2016-2017, 2017-2018, and 2018-2019, a total of 536 first-year medical students participated in this mandatory session. The course materials were developed as a collaboration between faculty and students. The lecture was delivered in a large-group format; the small-group case-based discussion consisted of 10-12 students with one upper-level student facilitator. Results The majority of respondents for the course evaluation felt that the course had met its stated objectives, and many commented that they had an increased awareness of the role of racism in shaping health. Students felt that the small-group activity was especially powerful for learning about racism. Discussion Active student involvement in curriculum development and small-group facilitation was critical for successful buy-in from students. Additional content on bias, stereotyping, and health care disparities will be the focus of faculty development programs and will also be integrated into the clerkships to build on these important topics as students are immersed in clinical care.
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Affiliation(s)
- Michelle DallaPiazza
- Assistant Professor, Department of Medicine, Division of Infectious Diseases, Rutgers New Jersey Medical School
| | | | - Megana Dwarakanath
- Resident,, Department of Pediatrics, University of New Mexico School of Medicine
| | | | - James Hill
- Associate Dean of Students, Department of Psychiatry, Rutgers New Jersey Medical School
| | - Maria L. Soto-Greene
- Professor of Medicine, Rutgers New Jersey Medical School; Vice Dean, Rutgers New Jersey Medical School; Director, Hispanic Center of Excellence, Rutgers New Jersey Medical School
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Abstract
OBJECTIVES The aims of this study were to determine differences in emergency department (ED) use by Native American (NA) children in rural and urban settings and identify factors associated with frequent ED visits. METHODS This cross-sectional, cohort study examined visits to 6 EDs: 2 rural, 2 midsize urban, and 2 large urban EDs from June 2011 to May 2012. Univariate and multiple regression analyses were conducted. Frequent ED visitors had more than 4 visits in the study period. RESULTS We studied 8294 NA visits (5275 patients) and 44,503 white visits (33,945 patients). Rural EDs had a higher proportion of NA patients, those below 200% of the income poverty level, and those who traveled more than 10 miles from their residence to attend the ED (all P < 0.05) compared with midsize and urban EDs. Native American patients had a high proportion of mental health diagnoses compared with whites (4.9% vs 1.9%, P < 0.001). Frequent ED visitors had greater odds of NA race, age younger than 1 year, public insurance, female sex, residence within less than 5 miles from the ED, and chronic disease. CONCLUSIONS Native American children seem to have greater challenges compared with whites obtaining care in rural areas. Native American children were more likely to be frequent ED visitors, despite having to travel farther from their residence to the ED. Native American children visiting rural and midsize urban EDs had a much higher prevalence of mental health problems than whites. Additional efforts to provide both medical and mental health services to rural NA are urgently needed.
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Weiser T, Bacon A, Corum B, Van Lew H, Groom A. Evaluation of an adult immunization composite measure in the Indian Health Service. Vaccine 2018; 36:4952-4957. [DOI: 10.1016/j.vaccine.2018.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/12/2018] [Accepted: 04/03/2018] [Indexed: 10/28/2022]
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Anderson E, Glogoza M, Bettenhausen A, Guenther R, Dangerfield D, Jansen R, Newman R, Warne D, Dyke C. Disparities in Cardiovascular Risk Factors in Northern Plains American Indians Undergoing Coronary Artery Bypass Grafting. Health Equity 2018; 2:152-160. [PMID: 30283862 PMCID: PMC6110186 DOI: 10.1089/heq.2018.0021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: Heart disease is the leading cause of death in American Indians (AIs). For AI patients with severe coronary artery disease requiring coronary artery bypass graft (CABG) surgery, little data exist. The purpose of this study was to evaluate short-term outcomes of Northern Plains AI undergoing CABG and identify variations in patient presentation. Methods: All patients undergoing isolated CABG between June 2012 and June 2017 were studied. Seventy-four AI and 1236 non-American Indian (non-AI) patients were identified. Risk factors, preoperative characteristics, cardiac status, procedural information, and outcomes were collected. Univariate analysis comparing short-term clinical outcomes between AI and non-AI populations was performed. Multivariable logistic regression models were constructed and outcome differences assessed. Unadjusted Kaplan-Meier survival estimates were produced using 5-year survival data. Results: AI patients presented with increased risk factors, including higher rates of diabetes mellitus (AI 63.5% vs. non-AI 38.7% p=< 0.001) and smoking/tobacco use (AI 60.8% vs. non-AI 20.0% p=> 0.001). Seventy-nine percent of AI patients resided on or near federal reservations and presented from rural locations. Internal mammary artery (IMA) graft use in both groups was high (AI 95.9% vs. non-AI 94.9% p=0.904), and multiarterial grafting with left internal mammary artery and radial artery use was common in both groups (AI 67.6% vs. non-AI 69.6% p=0.814). No significant differences in unadjusted 30-day mortality or short-term outcomes were detected. Adjusted Kaplan-Meier survival curves were similar between race groups up through 5 years after CABG (p-value=0.38). Conclusion: AIs presented with significantly more risk factors for cardiovascular disease compared with the general population, with especially high rates of insulin-dependent diabetes and active tobacco use. Despite this, outcomes were similar between groups. In propensity-matched groups, AIs were at decreased risk for prolonged length of stay and combined morbidity/mortality. In contrast to previous reports, AI racial identity did not adversely affect survival up to 5 years after CABG.
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Affiliation(s)
- Eric Anderson
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| | - Matthew Glogoza
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| | - Aaron Bettenhausen
- Department of Cardiothoracic Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Rory Guenther
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| | - Dylan Dangerfield
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| | - Rick Jansen
- Department of Public Health, North Dakota State University, Fargo, North Dakota
| | - Roxanne Newman
- Department of Cardiothoracic Surgery, Sanford Health Fargo, Fargo, North Dakota
| | - Donald Warne
- Department of Public Health, North Dakota State University, Fargo, North Dakota
| | - Cornelius Dyke
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
- Department of Cardiothoracic Surgery, Sanford Health Fargo, Fargo, North Dakota
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Pickner WJ, Ziegler KM, Hanson JD, Payne NR, Zook HG, Kharbanda AB, Weber TL, Russo JN, Puumala SE. Community Perspectives on Emergency Department Use and Care for American Indian Children. J Racial Ethn Health Disparities 2017; 5:939-946. [PMID: 29101687 DOI: 10.1007/s40615-017-0442-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/21/2017] [Accepted: 10/25/2017] [Indexed: 10/18/2022]
Abstract
Emergency department (ED) utilization by American Indian (AI) children is among the highest in the nation. Numerous health disparities have been well documented in AI children, but limited information is available on parental experiences of care for AI children in the ED. Our objective was to understand parental attitudes towards ED care for AI children. Focus groups were held with AI parents/caregivers at five sites in the Upper Midwest. Traditional content analysis was used to identify themes. A total of 70 parents participated in ten focus groups. Three main themes were identified: healthcare environment, access to care, and interaction with providers. Healthcare environment issues included availability of specialists, wait times, and child-friendly areas. Transportation and financial considerations were major topics in access to care. Issues in interaction with providers included discrimination, stereotyping, and trust. This is one of the first studies to assess parent perspectives on ED use for AI children. Obtaining parental perspectives on ED experiences is critical to improve patient care and provide important information for ED providers.
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Affiliation(s)
- Wyatt J Pickner
- Population Health, Sanford Research, 2301 East 60th Street North, Sioux Falls, SD, 57104, USA.,Department of Health Services, Community-Oriented Public Health Program, University of Washington School of Public Health, 1959 NE Pacific St, Magnuson Health Sciences Center, Room H-680, Box 357660, Seattle, WA, 98195-7660, USA
| | - Katherine M Ziegler
- Population Health, Sanford Research, 2301 East 60th Street North, Sioux Falls, SD, 57104, USA.,Department of Epidemiology, Colorado School of Public Health at the University of Colorado at Denver, 13001 E. 17th Place, B119 Bldg 500, 3rd Floor West Wing, Aurora, CO, 80045, USA
| | - Jessica D Hanson
- Population Health, Sanford Research, 2301 East 60th Street North, Sioux Falls, SD, 57104, USA
| | - Nathaniel R Payne
- Quality Improvement, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN, 55404, USA
| | - Heather G Zook
- Quality Improvement, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN, 55404, USA.,Evaluation Division, Professional Data Analysts, Inc, 219 Main St. SE, Suite 302, Minneapolis, MN, 55414, USA
| | - Anupam B Kharbanda
- Department of Emergency Medicine, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN, 55404, USA
| | - Tess L Weber
- Population Health, Sanford Research, 2301 East 60th Street North, Sioux Falls, SD, 57104, USA
| | - Jaymi N Russo
- Population Health, Sanford Research, 2301 East 60th Street North, Sioux Falls, SD, 57104, USA
| | - Susan E Puumala
- Population Health, Sanford Research, 2301 East 60th Street North, Sioux Falls, SD, 57104, USA. .,Department of Pediatrics, University of South Dakota Sanford School of Medicine, 1400 W 22nd St, Sioux Falls, SD, 57105, USA.
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Bernard K, Hasegawa K, Sullivan A, Camargo C. A Profile of Indian Health Service Emergency Departments. Ann Emerg Med 2017; 69:705-710.e4. [PMID: 28110985 DOI: 10.1016/j.annemergmed.2016.11.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/14/2016] [Accepted: 11/18/2016] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE The Indian Health Service provides health care to eligible American Indians and Alaskan Natives. No published data exist on emergency services offered by this unique health care system. We seek to determine the characteristics and capabilities of Indian Health Service emergency departments (EDs). METHODS All Indian Health Service EDs were surveyed about demographics and operational characteristics for 2014 with the National Emergency Department Inventory survey (available at http://www.emnet-nedi.org/). RESULTS Of the forty eligible sites, there were 34 respondents (85% response rate). Respondents reported a total of 637,523 ED encounters, ranging from 521 to 63,200 visits per site. Overall, 85% (95% confidence interval 70% to 94%) had continuous physician coverage. Of all physicians staffing the ED, a median of 13% (interquartile range 0% to 50%) were board certified or board prepared in emergency medicine. Overall, 50% (95% confidence interval 34% to 66%) of respondents reported that their ED was operating over capacity. CONCLUSION Indian Health Service EDs varied widely in visit volume, with many operating over capacity. Most were not staffed by board-certified or -prepared emergency physicians. Most lacked access to specialty consultation and telemedicine capabilities.
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Affiliation(s)
- Kenneth Bernard
- Department of Emergency Medicine, Tuba City Regional Health Care Corp, Tuba City, AZ.
| | - Kohei Hasegawa
- Department of Emergency Medicine and Emergency Medicine Network (EMNet), Massachusetts General Hospital, Boston, MA
| | - Ashley Sullivan
- Department of Emergency Medicine and Emergency Medicine Network (EMNet), Massachusetts General Hospital, Boston, MA
| | - Carlos Camargo
- Department of Emergency Medicine and Emergency Medicine Network (EMNet), Massachusetts General Hospital, Boston, MA
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Sequist TD. Urgent action needed on health inequities among American Indians and Alaska Natives. Lancet 2017; 389:1378-1379. [PMID: 28402807 DOI: 10.1016/s0140-6736(17)30883-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 03/24/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Thomas D Sequist
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA; Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Partners Healthcare System, Boston, MA 02199, USA.
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Guadagnolo BA, Petereit DG, Coleman CN. Cancer Care Access and Outcomes for American Indian Populations in the United States: Challenges and Models for Progress. Semin Radiat Oncol 2017; 27:143-149. [PMID: 28325240 PMCID: PMC5363281 DOI: 10.1016/j.semradonc.2016.11.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Low socioeconomic and health care access realities of being American Indian/Alaskan Native (AI/AN) in the United States combined with decades of data documenting poor cancer outcomes for this population provide a population nested within the United States that is analogous to the cancer care landscape of low- and middle-income countries internationally. We reviewed the medical literature with respect to cancer prevention, access to cancer treatment, and access to effective supportive and palliative care for AI/AN populations in the United States. Research confirms poorer cancer outcomes, suboptimal cancer screening, and high-risk cancer behaviors among AI/AN communities. AI/AN cancer patients are less likely to undergo recommended cancer surgeries, adjuvant chemotherapy, and radiation therapy than their White counterparts. Studies including both rural and urban survivors with AI cancer revealed barriers to receipt of optimal cancer symptom management and proportionally lower hospice use among AI/AN populations. Culturally tailored programs in targeted communities have been shown to mitigate the observed cancer-related health disparities among AI/AN communities. There is still much work to be done to improve cancer-related health outcomes in AI/AN communities, and the goals of the providers serving them corresponds with those propelling the growing interest in global oncology equity. Policy work and more funding are needed to continue to build upon the work that the Indian Health Service and established cancer-related health programs have begun in AI/AN communities.
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Affiliation(s)
- B Ashleigh Guadagnolo
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
| | | | - C Norman Coleman
- International Cancer Expert Corps, New York, NY; Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD
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Haozous EA, Doorenbos A, Alvord LA, Flum DR, Morris AM. Cancer Journey for American Indians and Alaska Natives in the Pacific Northwest
. Oncol Nurs Forum 2016; 43:625-35. [PMID: 27541555 PMCID: PMC5546748 DOI: 10.1188/16.onf.625-635] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe the experiences of American Indian and Alaska Native cancer survivors to improve understanding of the trajectory of cancer treatment.
. RESEARCH APPROACH Qualitative focus group research.
. SETTING Rural and geographically isolated American Indian and Alaska Native communities in the Pacific Northwest.
. PARTICIPANTS 30 American Indian and Alaska Native cancer survivors or caregivers.
. METHODOLOGIC APPROACH The authors analyzed data from two focus groups with cancer survivors by using thematic analysis informed by indigenous methodologies.
. FINDINGS Based on focus group findings, the authors developed a conceptual model of the cancer experience called Rough Waters. Participants described their cancer experience as a collective journey involving family and friends and requiring resources to offset challenges along the way. Dominant themes were delays, isolation, communication, money, advocacy, spirituality, and family involvement.
. CONCLUSIONS American Indians and Alaska Natives in the Pacific Northwest have special cultural needs during cancer care. The current study provides examples that can guide patient-provider interactions.
. INTERPRETATION Using the metaphor of cancer as a journey, clinicians can begin a dialogue to identify what will impede or assist the cancer journey for their American Indian and Alaska Native patients.
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Fathy C, Patel S, Sternberg P, Kohanim S. Disparities in Adherence to Screening Guidelines for Diabetic Retinopathy in the United States: A Comprehensive Review and Guide for Future Directions. Semin Ophthalmol 2016; 31:364-77. [PMID: 27116205 DOI: 10.3109/08820538.2016.1154170] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Diabetic retinopathy (DR) is the leading cause of new-onset blindness in American adults aged 20-74 years old. The number of diabetics living with diagnosed DR increased by 89%, from 4.06 million to 7.69 million, between 2000 and 2010. Projected numbers from the Vision Health Initiative by the CDC predict that the rate of DR will triple by 2050, from 5.5 million people living with DR to 16 million. Screening guidelines aim to detect cases early because the treatments for DR can reduce severe vision loss by up to 94%. However, adherence to these guidelines is quite low. It is estimated that more than half of patients with diabetes may fail to receive necessary screening. Risk factors for non-screening discussed in this study include low health literacy, lack of access to care, pregnancy, physician adherence to guidelines, unique factors present in different minority populations, gender and age disparities, and living in rural regions. This paper also aims to address potential interventions that may improve adherence rates.
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Affiliation(s)
- Cherie Fathy
- a Department of Ophthalmology and Visual Sciences , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Shriji Patel
- a Department of Ophthalmology and Visual Sciences , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Paul Sternberg
- a Department of Ophthalmology and Visual Sciences , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Sahar Kohanim
- a Department of Ophthalmology and Visual Sciences , Vanderbilt University Medical Center , Nashville , TN , USA
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Strasser-Weippl K, Chavarri-Guerra Y, Villarreal-Garza C, Bychkovsky BL, Debiasi M, Liedke PER, Soto-Perez-de-Celis E, Dizon D, Cazap E, de Lima Lopes G, Touya D, Nunes JS, St Louis J, Vail C, Bukowski A, Ramos-Elias P, Unger-Saldaña K, Brandao DF, Ferreyra ME, Luciani S, Nogueira-Rodrigues A, de Carvalho Calabrich AF, Del Carmen MG, Rauh-Hain JA, Schmeler K, Sala R, Goss PE. Progress and remaining challenges for cancer control in Latin America and the Caribbean. Lancet Oncol 2016; 16:1405-38. [PMID: 26522157 DOI: 10.1016/s1470-2045(15)00218-1] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 12/22/2022]
Abstract
Cancer is one of the leading causes of mortality worldwide, and an increasing threat in low-income and middle-income countries. Our findings in the 2013 Commission in The Lancet Oncology showed several discrepancies between the cancer landscape in Latin America and more developed countries. We reported that funding for health care was a small percentage of national gross domestic product and the percentage of health-care funds diverted to cancer care was even lower. Funds, insurance coverage, doctors, health-care workers, resources, and equipment were also very inequitably distributed between and within countries. We reported that a scarcity of cancer registries hampered the design of credible cancer plans, including initiatives for primary prevention. When we were commissioned by The Lancet Oncology to write an update to our report, we were sceptical that we would uncover much change. To our surprise and gratification much progress has been made in this short time. We are pleased to highlight structural reforms in health-care systems, new programmes for disenfranchised populations, expansion of cancer registries and cancer plans, and implementation of policies to improve primary cancer prevention.
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Affiliation(s)
- Kathrin Strasser-Weippl
- Centre for Oncology and Hematology, Wilhelminen Hospital, Vienna, Austria; The Global Cancer Institute, Boston, MA, USA
| | - Yanin Chavarri-Guerra
- The Global Cancer Institute, Boston, MA, USA; Hemato-Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Cynthia Villarreal-Garza
- Instituto de Cancerología, Centro de Cáncer de Mama, Tecnologico de Monterrey, Monterrey, Nuevo León, Mexico; Departmento de Investigación y de Tumores Mamarios, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Brittany L Bychkovsky
- Dana Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Marcio Debiasi
- Hospital Mae de Deus, Porto Alegre, Rio Grande do Sul, Brazil; Hospital Sao Lucas da PUCRS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Pedro E R Liedke
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Instituto do Câncer Mãe de Deus, Porto Alegre, Rio Grande do Sul, Brazil
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Cancer Care in the Elderly Clinic, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | - Don Dizon
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Eduardo Cazap
- Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina
| | - Gilberto de Lima Lopes
- Medical Oncology, Centro Paulista de Oncologia and Oncoclinicas do Brasil Group, São Paulo, Brazil; Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Diego Touya
- Department of Oncology, University of the Republic, Montevideo, Uruguay
| | | | - Jessica St Louis
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Caroline Vail
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Alexandra Bukowski
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Pier Ramos-Elias
- Instituto de Cancerología, Centro de Cáncer de Mama, Tecnologico de Monterrey, Monterrey, Nuevo León, Mexico
| | - Karla Unger-Saldaña
- Cátedra CONACYT, Unidad de Epidemiología, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | | | - Mayra E Ferreyra
- Oncology Department, Maria Curie Hospital, Buenos Aires, Argentina
| | - Silvana Luciani
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Angelica Nogueira-Rodrigues
- Federal University, Minas Gerais, Brazil; EVA-Group Brasileiro de Tumores Ginecológicos, Brazilian Gynecologic Oncology Group, Bahia, Brazil
| | | | - Marcela G Del Carmen
- Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jose Alejandro Rauh-Hain
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Raúl Sala
- Grupo Argentino de Investigación Clínica en Oncología-GAICO, Rosario, Santa Fe, Argentina
| | - Paul E Goss
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Aronson BD, Johnson-Jennings M, Kading ML, Smith RC, Walls ML. Mental health service and provider preference among American Indians with type 2 diabetes. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 2016; 23:1-23. [PMID: 28562840 PMCID: PMC5454776 DOI: 10.5820/aian.2301.2016.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In this study, we investigated mental health service and provider preferences of American Indian adults with type 2 diabetes from two tribes in the northern Midwest. Preferences were determined and compared by participant characteristics. After controlling for other factors, living on reservation lands was associated with increased odds of Native provider preference, and decreased odds of biomedical service preference. Anxiety also was associated with decreased odds of biomedical service preference. Spiritual activity engagement and past health care discrimination were associated with increased odds of traditional service preference. We discuss implications for the types of mental health services offered and characteristics of providers who are recruited for tribal communities.
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Roberts EB, Fleischhacker S, Pardilla M, Treuth M, Gadhoke P, Christiansen K, Gittelsohn J. Self-Reported Physical Activity Among American Indian Adults From Two Diverse Regions. J Rural Health 2015; 32:146-55. [PMID: 26717878 DOI: 10.1111/jrh.12168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Physical activity may be a protective factor against the disproportionate rates of chronic diseases faced by American Indians. Nevertheless, few studies report any cultural adoptions made to capture physical activity behaviors among this hard-to-reach population. Existing studies reporting the prevalence of physical activity among American Indians are often aggregated and tend to obscure regional, local, and tribal-level variations. This study examines the prevalence of physical activity and inactivity levels, along with associated factors, among rural dwelling American Indian adults from 2 distinct regions. METHODS Baseline self-reported data were collected using a culturally modified version of the International Physical Activity Questionnaire (IPAQ) short form during the Obesity Research Prevention and Evaluation of Intervention Effectiveness in Native North Americans trial (OPREVENT) among rural American Indian adults (aged 18-75 years) from 5 tribal communities in Michigan and New Mexico. FINDINGS Most participants were classified as moderately physically active (43.5%), and the majority reported access to physical activity facilities (83.5%). Michigan participants reported engaging in more moderate and total physical activity than those in New Mexico (P < .001) and reported spending less time sitting (P < .001). CONCLUSIONS Differences in physical activity among the American Indian communities may be due to regional variations in occupations, climate, and tribal and community support and infrastructure. The unexpected high level of activity evokes uncertainty in the accuracy and appropriateness of the data collection instrument. Research is needed to understand culturally appropriate approaches to measure physical activity and inactivity among rural American Indians.
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Affiliation(s)
- Erica Blue Roberts
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland
| | - Sheila Fleischhacker
- The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Office of Nutrition Research, Bethesda, Maryland
| | - Marla Pardilla
- Department of International Health, Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Margarita Treuth
- Department of Kinesiology, University of Maryland Eastern Shore, Princess Anne, Maryland
| | - Preety Gadhoke
- Department of Pharmacy Administration and Public Health, College of Pharmacy and Health Sciences, St. John's University, Queens, New York
| | - Karina Christiansen
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Joel Gittelsohn
- Department of International Health, Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Gonzales KL, Lambert WE, Fu R, Jacob M, Harding AK. Perceived racial discrimination in health care, completion of standard diabetes services, and diabetes control among a sample of American Indian women. DIABETES EDUCATOR 2014; 40:747-55. [PMID: 25249597 DOI: 10.1177/0145721714551422] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study is to examine perceived experiences of racial discrimination (perceived discrimination) in health care and its associations with completing standards of care for diabetes management and diabetes control. METHODS This cross-sectional study included 200 adult American Indian (AI) women with type 2 diabetes from 4 health care facilities located on tribal reservations in the Pacific Northwest. Participants completed a survey, and medical records were abstracted. Logistic regression was completed to assess associations. RESULTS Sixty-seven percent of AI women reported discrimination during their lifetime of health care. After adjusting for patient characteristics, perceived discrimination was significantly associated with lower rates of dental exam; checks for blood pressure, creatinine, and total cholesterol; and pneumococcal vaccination. The association between perceived discrimination and total number of diabetes services completed was not statistically significant. Perceived discrimination was associated with having A1C values above target levels for diabetes control in unadjusted and adjusted models, but no association was observed for blood pressure or total cholesterol. CONCLUSIONS In our sample of AI women with diabetes, two-thirds reported experiencing racial discrimination in their health care experience. Those reporting perceived discrimination completed fewer diabetes services and therefore may be at increased risk for comorbidities of diabetes. This finding supports the continued need for culturally responsive health care and programs of diabetes education to recognize perceived discrimination and its potential to impact success in self-management and services utilization.
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Affiliation(s)
| | - William E Lambert
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon (Dr Lambert, Dr Fu)
| | - Rongwei Fu
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon (Dr Lambert, Dr Fu)
| | - Michelle Jacob
- Department of Ethnic Studies, University of San Diego, San Diego, California (Dr Jacob)
| | - Anna K Harding
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon (Dr Harding)
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Dwojak SM, Finkelstein DM, Emerick KS, Lee JH, Petereit DG, Deschler DG. Poor Survival for American Indians with Head and Neck Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2014; 151:265-71. [PMID: 24781656 DOI: 10.1177/0194599814533083] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 04/04/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To examine patient characteristics, treatment modalities, and human papillomavirus (HPV) prevalence to identify potential mediators of disparities that may lead to differences in outcomes for American Indians with head and neck squamous cell carcinoma (HNSCC). STUDY DESIGN Historical cohort study. SETTING Community cancer centers. PATIENTS AND METHODS We reviewed all patients older than 18 years with a new diagnosis of HNSCC in South Dakota from 1999 to 2009. We assessed tissue samples from cases of oropharyngeal cancer for the presence of HPV DNA. RESULTS In total, 474 white patients were compared with 32 American Indians. American Indians experienced significantly worse survival compared with whites (hazard ratio [HR], 0.59; P = .05), even after controlling for other factors such as age, sex, distance, Charlson comorbidity index, alcohol abuse, smoking, insurance, and disease stage. American Indians had a greater risk of alcohol abuse (68% vs 42%; P = .008), current smoking (67% vs 49%; P = .03), living more than 1 hour from a cancer center (81% vs 30%; P < .001), lacking private insurance (24% vs 68%; P < .001), and late-stage disease presentation (stages III and IV) (74% vs 55%; P = .04). There were no detected differences in age, sex, medical comorbidities, tumor site, tumor grade, HPV status, time to treatment, or type of treatment received. CONCLUSION American Indians in South Dakota with HNSCC have poorer survival compared with white patients. Once presented to a cancer center, American Indians received nearly identical treatment to white patients. Disparities in outcomes arise primarily due to sociodemographic factors and later stage at presentation.
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Affiliation(s)
- Sunshine M Dwojak
- Department of Otolaryngology Massachusetts Eye and Ear Infirmary, and Harvard Medical School, Boston, Massachusetts, USA
| | - Dianne M Finkelstein
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kevin S Emerick
- Department of Otolaryngology Massachusetts Eye and Ear Infirmary, and Harvard Medical School, Boston, Massachusetts, USA
| | - John H Lee
- Sanford Cancer Research Center, Sioux Falls, South Dakota, USA
| | - Daniel G Petereit
- Rapid City Regional Hospital, John T. Vucurevich Cancer Care Institute, Rapid City, South Dakota, USA
| | - Daniel G Deschler
- Department of Otolaryngology Massachusetts Eye and Ear Infirmary, and Harvard Medical School, Boston, Massachusetts, USA
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Cho P, Geiss LS, Burrows NR, Roberts DL, Bullock AK, Toedt ME. Diabetes-related mortality among American Indians and Alaska Natives, 1990-2009. Am J Public Health 2014; 104 Suppl 3:S496-503. [PMID: 24754621 DOI: 10.2105/ajph.2014.301968] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed diabetes-related mortality for American Indians and Alaska Natives (AI/ANs) and Whites. METHODS Study populations were non-Hispanic AI/AN and White persons in Indian Health Service (IHS) Contract Health Service Delivery Area counties; Hispanics were excluded. We used 1990 to 2009 death certificate data linked to IHS patient registration records to identify AI/AN decedents aged 20 years or older. We examined disparities and trends in mortality related to diabetes as an underlying cause of death (COD) and as a multiple COD. RESULTS After increasing between 1990 and 1999, rates of diabetes as an underlying COD and a multiple COD subsequently decreased in both groups. However, between 2000 and 2009, age-adjusted rates of diabetes as an underlying COD and a multiple COD remained 2.5 to 3.5 times higher among AI/AN persons than among Whites for all age groups (20-44, 45-54, 55-64, 65-74, and ≥ 75 years), both sexes, and every IHS region except Alaska. CONCLUSIONS Declining trends in diabetes-related mortality in both AI/AN and White populations are consistent with recent improvements in their health status. Reducing persistent disparities in diabetes mortality will require developing effective approaches to not only control but also prevent diabetes among AI/AN populations.
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Affiliation(s)
- Pyone Cho
- Pyone Cho, Linda S. Geiss, and Nilka Rios Burrows are with the Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Diana L. Roberts is with Alaska Area Native Health Service, Indian Health Service (IHS), Anchorage. Ann K. Bullock is with Division of Diabetes Treatment and Prevention, IHS, Albuquerque, NM. Michael E. Toedt is with Cherokee Indian Hospital, Cherokee, NC
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James RD, Gold DE, St John-BlackBird A, Brown Trinidad S. Factors that influence mammography use among older American Indian and Alaska Native women. J Transcult Nurs 2014; 26:137-45. [PMID: 24626283 DOI: 10.1177/1043659614523994] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION American Indian and Alaska Native (AIAN) women have relatively high breast cancer mortality rates despite the availability of free or low-cost screening. PURPOSE This qualitative study explored issues that influence the participation of older AIAN women in mammography screening through tribally directed National Breast and Cervical Cancer Early Detection Programs (NBCCEDPs). METHODS We interviewed staff (n = 12) representing five tribal NBCCEDPs and conducted four focus groups with AIAN women ages 50 to 80 years (n = 33). RESULTS Our analysis identified four main areas of factors that predispose, enable, or reinforce decisions around mammography: financial issues and personal investments, program characteristics including direct services and education, access issues such as transportation, and comfort zone topics that include cultural or community-wide norms regarding cancer prevention. CONCLUSION This study has implications for nurse education and training on delivering effective mammography services and preventive cancer outreach and education programs in AIAN communities.
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Dwojak SM, Sequist TD, Emerick K, Deschler DG. Survival differences among American Indians/Alaska natives with head and neck squamous cell carcinoma. Head Neck 2012; 35:1114-8. [DOI: 10.1002/hed.23089] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2012] [Indexed: 11/11/2022] Open
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Lim HT, Choi KS. Factors Associated with Screening for Diabetic Retinopathy in Diabetic Patients Aged ≥ 40 Years Using the KNHANES IV. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.4.516] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Hyung Taek Lim
- Division of Preventive Ophthalmology, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoung Sub Choi
- Department of Ophthalmology, National Health Insurance Ilsan Hospital, Goyang, Korea
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Hall YN, Jolly SE, Xu P, Abrass CK, Buchwald D, Himmelfarb J. Regional differences in dialysis care and mortality among American Indians and Alaska Natives. J Am Soc Nephrol 2011; 22:2287-95. [PMID: 21980114 DOI: 10.1681/asn.2011010054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
American Indians/Alaska Natives (AIANs) compose a heterogeneous population that includes geographically distinct tribal communities, many with high rates of ESRD. Regional features of dialysis care and mortality are unknown in this population. Here, we describe the structure of dialysis care and mortality of adult AIANs who initiated maintenance dialysis during 1995-2008 in different regions of the US. Overall, 13,716 AIANs received dialysis at 2054 facilities. Approximately 10% (n = 197) of these facilities provided care to two-thirds (n = 9011) of AIANs. AIANs from the Southwest and Alaska were concentrated in relatively few dialysis facilities whereas those in the Eastern US and Pacific Coast were distributed more diffusely. Despite comparably high rates of poverty, diabetes, and cardiovascular disease, annual mortality rates were lower in the Southwest (13.9%) compared with the Southern Plains (23.2%), Alaska (21.2%), Eastern US (20.0%), Northern Plains (20.8%), and Pacific Coast (22.0%). These regional differences were consistent over time and persisted after adjusting for sociodemographic and clinical variables and area-based poverty. In conclusion, regional differences in the structure of dialysis care and patient mortality exist among AIANs. Southwestern AIANs experience the highest concentration of dialysis care and the lowest mortality. Our findings suggest that an area-based approach examining the care structure of relatively few dialysis facilities may delineate determinants of these differences and improve the quality of care to many AIAN communities.
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Affiliation(s)
- Yoshio N Hall
- Kidney Research Institute, University of Washington, 325 9th Avenue, Box 359606, Seattle, WA 98104, USA.
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Sequist TD, Cullen T, Acton KJ. Indian Health Service Innovations Have Helped Reduce Health Disparities Affecting American Indian And Alaska Native People. Health Aff (Millwood) 2011; 30:1965-73. [DOI: 10.1377/hlthaff.2011.0630] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Thomas D. Sequist
- Thomas D. Sequist is an associate professor of medicine and health care policy at Harvard Medical School and Brigham and Women’s Hospital, in Boston, Massachusetts
| | - Theresa Cullen
- Theresa Cullen is the director of health domain information technology at the Department of Health and Human Services in Washington, D.C
| | - Kelly J. Acton
- Kelly J. Acton is the deputy regional health administrator for Department of Health and Human Services Region IX, in San Francisco, California
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