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Thursday, June 19, 2014

Barriers to Healthcare: Difference in Disease Mortality Rates Between Social Groups

While it is understood that, by and large, diseases don’t differentiate between hosts – that is, one warm body is about the same as another to a virus or bacterium – there are certain illnesses that seem to be more prevalent within specific groups.

For example: Caucasians show higher instances of Crohn’s disease, cystic fibrosis, osteoporosis, skin cancer, and celiac disease.; while African Americans show higher instances of type 2 diabetes, sickle cell anemia, systemic lupus erythematosus (SLE), heart disease, and hypertension.

Disease prevalence isn’t the only issue. Certain ethnic groups also have vastly different survival rates when it comes to certain diseases. For example, African Americans tend to have lower cancer survival rates than other segments of the population; and women have more heart attack fatalities than men. While we can understand some of the genetic factors associated with disease prevalence, what are the factors that contribute to the difference of survival rates?

A Difficult Topic

When discussing the health differences between certain groups – be they ethnic, racial, or gender-based – it’s impossible to do so without also discussing ethnicity, race and gender. All human being bodies are basically the same and should respond similarly when confronted with disease. That is, a body with diabetes should have the same response to the disease, be it male, female, African American, Latino, Caucasian or anyone else.

However, that does not seem to be the case; and that may have more to do with several external factors.

Access to Care

Even as the Affordable Care Act (ACA) is making it possible for more people to have access to care, people are still falling through the gaps. In states that refuse to expand Medicaid, thousands of poor are unable afford coverage. Additionally, individuals who don’t meet the economic qualifications for Medicaid, or for a subsidized plan, might still be unable to afford an individual ACA-compliant plan. While insurance companies like USHealth Group Private are working hard to make their services accessible and reach those who have been overlooked, there are still people without healthcare coverage.

Lack of healthcare coverage means people are less likely to seek medical care when they initially become sick, may postpone treatment when diagnosed, or may only be able to do partial treatments – all of which can lead to higher mortality rates.

Bias Among Healthcare Practitioners

In a 2003 report, called Unequal Treatment, the Institute of Medicine concluded that some healthcare professionals hold unrecognized biases against members of certain social groups, such as the obese and ethnic minorities; and that these unrecognized biases often negatively affect the quality of care given to these groups.

One example of an unrecognized bias affecting patient morality is the case of Lisa Smirl. Ms. Smirl was a 37-year-old college professor who began experiencing lung symptoms in the Fall of 2010. Over the course of a year she saw several physicians who diagnosed her with several un-related illnesses including asthma, migraines, and depression. In November of 2011, after taking 10 times her prescribed asthma medication did not resolve her symptoms, she was finally diagnosed with Stage IV adenocarcinoma with extensive metastasis to the bones, brain, and liver. She died in February 2013.

Shortly before she died she stated: “I can’t prove it, and this is just my opinion, but I have no doubt in my own mind that my misdiagnosis was in large part due to the fact that I was a middle aged female and that my male doctors were preconceived towards a psychological rather than a physiological diagnosis.”

Since that 2003 report was released there have been several other studies on unconscious bias and health disparities with an eye toward fostering awareness of these biases, and finding solutions to better care.

Cultural Factors

Doctors and the insurance industry are not the only factors when it comes to discrepancies in patient care. The patient’s own cultural framework can also play a part.

For example, in some cultures certain illnesses may carry a stigma that prevents individuals from seeking care. Patients who are ethnically, culturally, or racially disenfranchised may also feel a large measure of distrust toward the medical establishment, especially if there is a history medical mistreatment.

The combined factors of lack of access, health provider bias, and cultural mistrust of the medical establishment causes people to neglect their health, which results delayed diagnoses and reduced standards of care – all of which lead to higher mortality rates for certain social groups.

This is a post by Nancy Evans

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