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2003-12-23 -- Two reports on racial disparities in health

Health and Human Services reports less cancer screening and higher
death rates for poor and minorities. Improvements found in other
areas, according to the National Healthcare Quality Report and the
National Healthcare Disparities Report.


The gap in severity of prostate cancer at time of diagnosis between
white and African-American men has narrowed sharply, but prostate
cancer is diagnosed in black Americans at twice the rate of whites,
and blacks are twice as likely to die of it.


Associated Press, Tue Dec 23, 2003


WASHINGTON - The Health and Human Services Department has found a
higher death rate for cancer among blacks and low-income Americans in
its review of the nation's health care system.

Those groups are less likely to be screened for certain cancers and
less likely to avail themselves of other preventive services,
according to the two studies released Monday by the department.

The reports also found low-income people are less likely to have a
regular doctor and more likely to visit the hospital for conditions
that could be treated elsewhere.

HHS Secretary Tommy Thompson said the studies show areas in which the
nation has improved health care, "but more importantly, it shows us
where we have more work to do and how we can make sure that all
Americans benefit from scientific advances and technological
innovations."

One report evaluated the quality of national health care and the other
examined disparities. The department conducted the studies to fulfill
a congressional requirement to review the health care system,
particularly the treatment provided to women, children, minorities and
the poor.

Among the problems found by the studies:

  *  Children under 4 who are poor or black are less likely to receive
immunizations.

  *  Only 20 percent of patients prescribed a medication to treat
diagnosed depression have at least 3 recommended follow up visits to
monitor their medication in the 12 weeks after diagnosis.

  *  Less than half of acute heart attack patients who smoke are
counseled to quit while in the hospital.

  *  While 90 percent of adults 45 or older have their blood pressure
checked, only about 25 percent of people with high blood pressure have
it under control.

The department said progress has been made in these areas:

  *  Seventy percent of women over 40 were screened for breast cancer
within the past two years and 81 percent of women over 18 had a
cervical cancer screening within the past three years.

  *  Almost 90 percent of in-center kidney dialysis patients get
adequate dialysis.

  *  Approximately 83 percent of women have prenatal care in their
first trimester.

  *  More than 80 percent of Medicare recipients hospitalized with
pneumonia get the type of antibiotics they need after a prompt
evaluation.

On the Net:


DHHS reports: http://www.qualitytools.ahrq.gov




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New York Times, December 23, 2003

Disparities: Prostate Cancer: A Racial Divide
By JOHN O'NEIL

The gap in severity of prostate cancer at time of diagnosis between
white and African-American men has narrowed sharply since the advent
of guidelines calling for black men to begin screening for the cancer
at a younger age, a new study concludes.

The study, which tracked over 2,000 cases in Michigan, found that the
cancer was being caught at earlier stages in both white and black
patients than it was a decade ago, but that the change has been much
bigger among blacks.

Prostate cancer is diagnosed in black Americans at twice the rate of
whites, and blacks are twice as likely to die of it, a gap brought
back to public attention last week by the announcement that Secretary
of State Colin L. Powell had undergone surgery to remove a prostate
tumor.

While researchers are still unsure how much of that gap is due to
biological differences and how much is related to more restricted
access to care, the American Cancer Society in 1997 recommended that
black men begin screening for prostate cancer at age 45, rather than
50, the guideline for the male population at large.

In the new study, which was published in the official journal of the
American Society for Therapeutic Radiation and Oncology, Dr. Charlie
C. Pan of the University of Michigan led a group that collected data
on a pool of prostate cancer patients between 1990 and 2001.

The researchers found that between 1990 and 1996, the median initial
prostate specific antigen levels - a blood marker that indicates how
advanced the disease is at time of diagnosis - were 15.8 for black
patients and 10.2 for whites.

Between 1997 and 2001, the levels at time of diagnosis were 9.8 for
black patients and 8.4 for whites.

While the results do not prove a link between the change in guidelines
and the narrowing of the gap, Dr. Pan said they provided support for
the practice.