Racial/Ethnic disparities in monitoring metabolic parameters for patients with schizophrenia receiving antipsychotic medications.

OBJECTIVE: Patients with schizophrenia experience risks for metabolic dysregulation from medications and lifestyle behaviors. Although most patients with schizophrenia in the Veterans Health Administration (VA) receive antipsychotics, variation in monitoring metabolic dysregulation by race/ethnicity has not been assessed. This study analyzed differential monitoring of metabolic parameters by minority status. METHODS: This retrospective study approximated the five components of metabolic syndrome (fasting glucose, high-density-lipoprotein cholesterol, triglycerides, blood pressure, and large waistline) using archival data, substituting body mass index for waistline. VA patients with schizophrenia age 50 or older were followed from October 1, 2001 through September 2009 (N = 30,258). Covariates included age, gender, race (white, black), Hispanic ethnicity, region, marital status, VA priority status, comorbidity, and antipsychotic type. Repeated-measures analysis assessed the association of race/ethnicity with metabolic monitoring. RESULTS: Average patients age was 59 years (standard deviation: 9; range: 50-101), 97% were men, 70% white, 30% black, and 8% Hispanic. At baseline, 6% were monitored on all five metabolic components; this increased to 29% by 2005. In adjusted models, blacks were less likely to be monitored on all parameters, whereas Hispanics were less likely to have glucose and high-density-lipoprotein cholesterol monitored but more likely to have triglycerides tested. By 2009, lab assays were similar across race and ethnicity. CONCLUSION: Guideline-concordant monitoring metabolic parameters appear to be equitable but low and somewhat at odds with racial/ethnic risk among older patients with schizophrenia. Physicians should discuss lipids, weight, and glucose with patients at risk for developing heart disease, diabetes, and other sequelae of the metabolic syndrome.

Correlates of initiating colorectal cancer screening beginning at age 50.

This study examined (a) differences in rates of initiating colorectal cancer screening across age groups, and (b) factors associated with initiation of colorectal cancer screening among persons age 50-75. Data from 1,699 adults age 50-75 were analyzed from a random sample of households in an eight-county region surrounding the Brazos Valley in Texas. Bivariate descriptive analyses were performed. Logistic regression was employed to assess relationships between demographic, health status, and healthcare utilization variables and having initiated colorectal cancer examination. Having more than a high school education (OR = 1.48, p = 0.002), having insurance (OR = 1.76, p = 0.007), being obese (OR = 1.58, p = 0.015), and having a routine health check-up within the past 2 years (OR = 3.39, p < 0.001) were associated with an increased likelihood of having a colorectal cancer examination. The findings suggest that routine interactions with health care providers may encourage persons to initiate colorectal cancer screening according to guidelines.

Associations among physical activity, body mass index, and health-related quality of life by race/ethnicity in a diverse sample of breast cancer survivors.

BACKGROUND: Health-related quality of life (HRQOL), body mass index (BMI), and physical activity (PA) levels have all been associated with prognosis following breast cancer and may explain partially the higher mortality for breast cancer in certain racial/ethnic subgroups. In this study, associations between PA, BMI, and HRQOL by race were examined in a sample of breast cancer survivors. METHODS: Measures of PA, BMI, and HRQOL as well as demographic and medical characteristics of women (N = 3013, 13% nonwhite) who participated in the Women's Healthy Eating and Living Study were assessed at baseline. Analysis of covariance was used to examine the relationship between PA and obesity with HRQOL outcomes. Statistical tests were 2-sided. RESULTS: African American women were less likely to meet guidelines for PA and more likely to be obese than women from other ethnic groups (P < .05). In adjusted models, women who met guidelines for PA reported significantly higher physical health composite (point differences ranged from 10.5 to 21.2 points, all P < .05) and vitality (point differences ranged from 9.9 to 16.5 points, all P < .05) scores than those who did not, regardless of race/ethnicity. Associations between obesity and HRQOL were mixed with fewer associations for Asian American and African American women and stronger associations for whites. CONCLUSIONS: Breast cancer survivors from racially and ethnically diverse populations have lower levels of PA and higher rates of obesity that are generally associated with poorer HRQOL. Culturally sensitive PA and weight loss interventions may improve these lifestyle characteristics and result in improved HRQOL.

Self-reported colorectal cancer screening of Medicare beneficiaries in family medicine vs. internal medicine practices in the United States: a cross-sectional study.

BACKGROUND: The benefit of screening for decreasing the risk of death from colorectal cancer (CRC) has been shown, yet many patients in primary care are still not undergoing screening according to guidelines. There are known variations in delivery of preventive health care services among primary care physicians. This study compared self-reported CRC screening rates and patient awareness of the need for CRC screening of patients receiving care from family medicine (FPs) vs. internal medicine (internists) physicians. METHODS: Nationally representative sample of non-institutionalized beneficiaries who received medical care from FPs or internists in 2006 (using Medicare Current Beneficiary Survey). The main outcome was the percentage of patients screened in 2007. We also examined the percentage of patients offered screening. RESULTS: Patients of FPs, compared to those of internists, were less likely to have received an FOBT kit or undergone home FOBT, even after accounting for patients' characteristics. Compared to internists, FPs' patients were more likely to have heard of colonoscopy, but were less likely to receive a screening colonoscopy recommendation (18% vs. 27%), or undergo a colonoscopy (43% vs. 46%, adjusted odds ratios [AOR], 95% confidence interval [CI]-- 0.65, 0.51-0.81) or any CRC screening (52% vs. 60%, AOR, CI--0.80, 0.68-0.94). Among subgroups examined, higher income beneficiaries receiving care from internists had the highest screening rate (68%), while disabled beneficiaries receiving care from FPs had the lowest screening rate (34%). CONCLUSION: Patients cared for by FPs had a lower rate of screening compared to those cared for by internists, despite equal or higher levels of awareness; a difference that remained statistically significant after accounting for socioeconomic status and access to healthcare. Both groups of patients remained below the national goal of 70 percent.

Perceptions of Chronic Disease Among Older African Americans: A Qualitative Analysis.

Research has documented that African Americans suffer disproportionately from chronic diseases when compared to the general population. Yet, limited research examines older African Americans' perceptions about having chronic diseases. Accordingly, the first aim of the study provided insight into this disparity with the intent of revealing how older African Americans feel about their overall health, and how much they understand about their individual chronic disease(s). The second aim was to gather information about strategies and coping mechanisms older African Americans use to manage their chronic diseases. The purpose of this aim was to determine if any of the strategies they employed were related to the positive health outcomes. Two focus groups were conducted with African American older adults who live in community settings. The results from the focus groups indicate that older African Americans are aware of the conditions they have and have developed strong coping methods to help them manage. Recommendations are provided for future research studies and chronic disease management programs.

A review of our roots: blacks in gerontology.

The historical underpinnings in the field of gerontology rest on the contributions of scholars across a myriad of racial and ethnic backgrounds. With the increasing diversity of the adult population, there is a need to increase the number of researchers who study older adults from diverse racial and ethnic populations in general and Black elderly people in particular. Furthermore, it is important to document the participation of Black older adults in our earliest and continuing research efforts. Understanding the historical context and the foundational influence of Black scholars in this field is critical. To realize its humble beginnings, one must become aware of the contributions by Black scholars who have a vested interest in the aging process. With universal similarities and unique differences among older adults, there is a need to acknowledge the past and current scholarship of those who study the aging processes of Blacks while marveling over the future possibilities. The purpose of this review is to elucidate the legacy and current contributions, philosophies, and research of Black scholars in the field of gerontology. In addition, exploration of the theoretical and conceptual frameworks used to establish national and organizational initiatives is reviewed. The impetus in initiating and continuing this work requires a "knowledge of our roots" while moving into the future. It is important to learn the history and significance of Black scholars in gerontology, the contributions of older Blacks, and appreciate the resiliency and marveled life course of this unique population.

Satisfaction with care: the role of patient-provider racial/ethnic concordance and interpersonal sensitivity.

OBJECTIVE: This study examined how patients' satisfaction with their care is affected by racial/ethnic concordance and patients' perceived interpersonal sensitivity of their providers. The sample consisted of non-Hispanic Whites, African Americans/Blacks, Hispanics/Latinos, and Asian Americans age 50 and older. METHOD: Data came from the population-based Commonwealth Fund 2001 Health Care Quality Survey (n=2,075). A hierarchical regression model of satisfaction was estimated for each racial/ethnic group with a sequential entry of variables: demographic and health-related variables, racial/ethnic concordance between patient and provider, and interpersonal sensitivity. RESULTS: The influence of patient-provider racial/ethnic concordance on satisfaction with care was negligible, but the influence of interpersonal sensitivity was substantial (p<.001) in all racial/ethnic groups. DISCUSSION: Findings suggest that racial/ethnic concordance may not be universally effective for diverse older populations, but perceived interpersonal sensitivity of the provider has a strong influence on older adults' satisfaction with care regardless of their racial/ethnic background.

Patients' perceptions of the interpersonal sensitivity of their healthcare providers: the potential role of patient-provider racial/ethnic concordance.

BACKGROUND: Preliminary studies have revealed an association between cultural competence and an improvement in the quality of healthcare services, increased patient satisfaction, and increased effectiveness of services. OBJECTIVE: This study examined factors that helped to explain patients' perceptions of their providers' interpersonal sensitivity - one component of cultural competence. METHODS AND PARTICIPANTS: The respondents were 2075 racially/ethnically diverse adults, aged 50 years and older, who responded to a national telephone survey. RESULTS: Results indicate that one of the main factors predicting interpersonal sensitivity is self-rated physical health: those who reported better health were more likely to see their provider as exhibiting higher levels of sensitivity. This was true for Hispanic/Latino patients. The results also suggest that having a provider of the same race/ethnicity was a significant factor only for Hispanic/Latino patients. CONCLUSION: Despite findings from previous research, racial/ethnic concordance may not be universally effective in improving interpersonal sensitivity in healthcare settings for all racial/ethnic groups.

Correlates of volunteering among aging Texans: the roles of health indicators, spirituality, and social engagement.

OBJECTIVES: This study aimed to identify participant characteristics associated with volunteering among older adults. METHODS: Based on data from the 2008 Aging Texas Well (ATW) Indicators Survey, we examined the degree to which demographic factors, health status, spiritual participation, and community involvement are associated with volunteering among adults aged 60 years or older (n = 525). RESULTS: Rates of volunteering varied by race/ethnicity: non-Hispanic Whites (56.4%), African Americans (51.1%), and Hispanics (43.2%). Bivariate analyses showed that non-Hispanic White older adults were more likely to participate in formal volunteering activities, while their African American and Hispanic counterparts tended to participate in informal volunteering activities. Logistic regression analyses revealed that volunteering was less observed among Hispanics (OR = 0.48, 95% CI 0.29-0.78). Volunteering was more observed among those who reported providing informal care (OR=1.93, 95% CI 1.14-3.28), having very good or excellent mental health (OR = 1.90 and 2.07, 95% CI 1.09-3.32 and 1.20-3.55, respectively), having weekly or daily spiritual participation (OR = 2.15 and 2.35, 95% CI 1.28-3.63 and 1.29-4.28, respectively), perceiving community involvement very important (OR = 2.37, 95% CI 1.55-3.62), and being very satisfied with the community interaction (OR = 1.81, 95% CI 1.15-2.85). CONCLUSIONS: Given the positive associations of mental health, spirituality, and social engagement with volunteering among older adults, system-level efforts to increase the sense of community among older adults and recognize their roles as volunteers will be helpful in recruiting and retaining older volunteers.

Ethnicity and Race Variations in Receipt of Surgery among Veterans with and without Depression.

To examine equity in one aspect of care provision in the Veterans Health Administration, this study analyzed factors associated with receipt of coronary artery bypass graft (CABG), vascular, hip/knee, or digestive system surgeries during FY2006-2009. A random sample of patients (N = 317, 072) included 9% with depression, 17% African-American patients, 5% Hispanics, and 5% women. In the four-year followup, 18,334 patients (6%) experienced surgery: 3,109 hip/knee, 3,755 digestive, 1,899 CABG, and 11,330 vascular operations. Patients with preexisting depression were less likely to have surgery than nondepressed patients (4% versus 6%). In covariate-adjusted analyses, minority patients were slightly less likely to receive vascular operations compared to white patients (Hispanic OR = 0.88, P < .01; African-American OR = 0.93, P < .01) but more likely to undergo digestive system procedures. Some race-/ethnicity-related disparities of care for cardiovascular disease may persist for veterans using the VHA.