Reducing Health Inequities in the U.S.: Recommendations From the NHLBI's Health Inequities Think Tank Meeting.

The National, Heart, Lung, and Blood Institute convened a Think Tank meeting to obtain insight and recommendations regarding the objectives and design of the next generation of research aimed at reducing health inequities in the United States. The panel recommended several specific actions, including: 1) embrace broad and inclusive research themes; 2) develop research platforms that optimize the ability to conduct informative and innovative research, and promote systems science approaches; 3) develop networks of collaborators and stakeholders, and launch transformative studies that can serve as benchmarks; 4) optimize the use of new data sources, platforms, and natural experiments; and 5) develop unique transdisciplinary training programs to build research capacity. Confronting health inequities will require engaging multiple disciplines and sectors (including communities), using systems science, and intervening through combinations of individual, family, provider, health system, and community-targeted approaches. Details of the panel's remarks and recommendations are provided in this report.

Race, culture, and trust: why should I take a shot if I'm not sick?

This three-part panel discussion provides information on: 1) the role religious leaders can take in influencing health care, health access, and compliance; 2) barriers to equal health care and major gaps in immunizations among Hispanics; and 3) population management strategies for public health officials and private practice physicians. Citing barriers such as mistrust of government programs, socioeconomic conditions, lack of access to preventive healthcare services, cultural attitudes, and lack of education about immunizations, the speakers also offered solutions to overcome resistance to immunization. Panel members supported these strategies and provided techniques to implement the strategy: engaging faith-based organizations, improving patient-provider communication; and creating public health initiatives to be culturally competent.

Medication use, emergency hospital care utilization, and quality-of-life outcome disparities by race/ethnicity among adults with asthma.

OBJECTIVES: To examine the association of race/ethnicity with medication use, emergency hospital care (EHC) utilization, and quality-of-life outcomes in a population with persistent asthma and to determine if factors related to severity of illness, treatment characteristics, and demographic, socioeconomic, and smoking status explain differences in study outcomes. STUDY DESIGN: Retrospective analysis. METHODS: We examined survey and administrative data for 974 adults with persistent asthma enrolled in a group-model health maintenance organization. Patients with persistent asthma were identified in 1999 using Healthcare Effectiveness Data and Information Set inclusion criteria. In 2000, the same patients were surveyed regarding quality of life using the Mini Asthma Quality of Life Questionnaire. In 2001, the use of controller medications, the ratio of controller medications to rescue medications, and EHC utilization were identified by electronic medical record. Multiple logistic regression and linear regression analyses were used to evaluate the independent association of race/ethnicity with study outcomes after adjusting for severity of illness, treatment characteristics, and demographic, socioeconomic, and smoking status. RESULTS: Compared with whites, African Americans (standardized ß coefficient, -0.12) and Native Americans/Aleutians/Eskimos (standardized ß coefficient, -0.14) had lower Mini Asthma Quality of Life Questionnaire scores (P <.05 for both). African Americans were significantly (P <.05) more likely to report EHC utilization (odds ratio, 5.2; 95% confidence interval, 2.6-10.3). CONCLUSIONS: Disparities existed in 2 outcome measures, Mini Asthma Quality of Life Questionnaire scores and EHC utilization. A concerning finding is that African Americans were at least 5 times more likely to report higher EHC utilization, even after adjusting for factors such as income and education.