Unequal access: Hispanic children rarely get top-notch care for brain tumours
Science Centric | 11 October 2009
Hispanic children diagnosed with brain tumours get high-quality treatment at hospitals that specialise in neurosurgery far less often than other children with the same condition, potentially compromising their immediate prognosis and long-term survival, according to research from Johns Hopkins published in October's Pediatrics.
More than a decade after the Institute of Medicine's landmark report Crossing the Quality Chasm, the Hopkins investigators say their findings detect persistent gaps in access to specialised care among certain patients, raising questions about how far across the chasm we have actually come.
'What was shocking to us was the finding that, despite the push over the last decade to equalize access to high-quality care, gaps are still there, particularly among Hispanics, and, if anything, they may be getting even worse,' said lead investigator Raj Mukherjee, M.D., M.P.H., a postdoctoral fellow in the Department of Neurosurgery at Hopkins.
Research has shown that patients treated at speciality hospitals that admit a high volume of patients with similar conditions fare better in the long and short term, investigators say. For example, studies show that patients undergoing brain surgeries in hospitals that perform the fewest neurosurgeries have up to 16 times the mortality rate of patients treated in hospitals performing the highest number.
'Given that brain tumours are the most common solid tumours in children, lack of access to specialised care simply means that thousands of paediatric patients are getting less-than-optimal treatment, putting them at risk for relapse and a host of neurological complications,' says paediatric neurosurgeon George Jallo, M.D., co-author on the study and director of Neurosurgery at Johns Hopkins Children's Centre.
The Hopkins study, which looked at 4,421 children with brain tumours over the span of 18 years, found that access was worst among Hispanics, as well as among those of lower socio-economic status and those living in areas with higher immigrant population and with few neurosurgeons. Insurance did not play a role in where a patient was treated, the researchers found. The Hopkins team linked two databases - one detailing hospital and patient information and another one with demographic and environmental information - elucidating in a novel way the impact of such factors as ethnicity and proportion of foreign-born people in the county of residence.
Overall, only 37 percent of the patients in the study who should have been treated at a high-volume hospital had surgeries in such institutions. Hispanics consistently fared worse than the others: Even when adjusting for factors that may affect access to care, such as socioeconomic status and health insurance, Hispanic children still got specialised care at one-third the rate of other children, the Hopkins team found.
'If you're a Hispanic child diagnosed with a brain tumour, you're far less likely to get the best possible treatment, and this is concerning in and of itself, but there's another looming threat emerging from our findings,' said senior investigator Alfredo Quinones-Hinojosa, M.D., associate professor of Neurosurgery and Oncology at Hopkins. 'Hispanics will make up 25 percent of this country's population by the year 2050, so unless we do something about this, it looks like in the next few decades, a quarter of our population may end up getting substandard care.'
'Our findings are yet another reminder that we are at a unique crossroad in history as we try to restructure our healthcare system, and we have been given a chance to reduce, perhaps even eliminate, these inequalities once and for all,' Quinones adds.
Researchers say that pinpointing the exact factors that determine who gets care and where they get it requires carefully designed studies that examine individual patient decision-making, as well as systemic factors, such as insurance and possible institutional bias in patient selection.
Source: Johns Hopkins Medicine
Showing posts with label Latino Health Sudies. Show all posts
Showing posts with label Latino Health Sudies. Show all posts
Wednesday, October 14, 2009
Wednesday, April 8, 2009
Research shows 1 in 5 kids obese
It's not baby fat: Among 4-year-olds, nearly 1 in 5 is obese
By Madison Park, CNN
Nearly one-fifth of American 4-year-olds are obese, and children of color are at higher risk, according to new research.
Obese children are at risk for early onset of diabetes, fatty liver and musculoskeletal problems.
Obese children are at risk for early onset of diabetes, fatty liver and musculoskeletal problems.
Researchers calculated the body mass index from a sample of 8,550 Hispanic, black, white, Asian and Native American 4-year-olds. The children were born in 2001, and in 2005, their height and weight were measured -- 18.4 percent of them were obese.
"Significant differences in the prevalence of obesity between racial/ethnic groups were evident at 4 years of age," the researchers wrote in the April issue of the Archives of Pediatrics and Adolescent Medicine.
Using body mass index, they found that 31.2 percent of American Indian/Native Alaskans, 22 percent of Hispanics, 20.8 percent of blacks, 15.9 percent of whites and 12.8 percent of Asians were obese.
"It's surprising that there are large differences by racial/ethnic group by that age," said Sarah Anderson, an assistant professor of epidemiology at The Ohio State University and lead study author.
Anderson and co-author Robert Whitaker's analysis showed that children were becoming obese even before encountering soda and candy vending machines in schools.
"These results really do point to the need for us to focus attention on early childhood and the need for research to understand how these differences can emerge so early," Anderson said. "To do that, we may need to understand the different family and cultural factors that are at play in these children's lives."
The cause for the early health disparities is hard to pinpoint, childhood obesity experts said.
"It's always possible there are biological factors within ethnic groups," said Dr. Tom Robinson, director of the Center for Healthy Weight at the Stanford University School of Medicine. "We know most of the changes that have occurred in body fat tend to occur from being in an environment that promotes very easy access to high-caloric foods and limited opportunities for physical activities."
Michael Rich, an associate professor of pediatrics at Harvard Medical School, called the disparities between ethnic groups disturbing.
"The expectations, lifestyle, behaviors are different on a cultural and socioeconomic basis," he said. "Kids who live in the inner city, whose neighborhoods are perceived as dangerous, stay at home more, sit more, eat more snacks, because that's all they can get at the local bodega. There are no supermarkets to get produce. That's what mom is eating, so that's what kid is eating. What we're dealing with here is whole life issues."
Previous research has shown that older children are becoming less active and spending more time in front of a computer or TV.
"That is displacing physical activity," said Dr. Sarah Barlow, director of the Obesity Center at Texas Children's Hospital in Houston. "You can imagine strollers, less outdoor play -- all those kinds of things that have shifted how much activity younger kids are getting. At the same time, portion sizes are increasing for everybody."
According to data from the Centers for Disease Control and Prevention, adults fare no better. Approximately 45 percent of blacks, 36.8 percent of Mexican Americans and 30 percent of whites are obese.
"It's a very bad sign if we see obesity at a young age," Robinson said. "When we see children obese at age 4, we're likely to see complications -- high blood pressure, abnormal lipids -- which can lead to heart disease and stroke, diabetes in children."
Diseases commonly seen in 40- or 50-year-olds are presenting in 6- and 7-year-olds. Obese children are developing type 2 diabetes, fatty liver disease and musculoskeletal problems, which occur because their bodies can't carry that much weight, doctors said. Calculate your child's body mass index.
"The heavier you are as a child, the likelier that extra weight will follow you through life," Robinson said. "That's why we see adolescents who need weight-loss surgery, because they have life-threatening complications from obesity."
If you have an obese child...
The first step is for the parents to acknowledge that the child is overweight, instead of making excuses or comparing him or her to heavier children. Many of the parents of obese children are overweight themselves, which makes that acknowledgment difficult, said Rich, who is also director of the Center on Media and Child Health at Children's Hospital in Boston.
"While it's important to focus on it and take it seriously, it's also important not to give up or feel hopeless," he said. "Then you won't try. You want to look at it for what it is and not be defeated by it."
When you're trying to help your child achieve a healthy weight, remove the stigma attached to obesity.
"It should always be about health, not about losing weight," Rich said. "You're trying to build the positive."
He recommended the 5-2-1-0 plan. Eat at least five servings of fruits and vegetables, cut screen time down to two hours or less, exercise at least one hour, and have zero soda and sugary drinks.
Such changes, which are not seismic shifts to lifestyles, can help the child get into a health weight.
"It's easier to start that way, rather than try to change habits when they're 8 or 12 or 16," said Barlow, an associate professor of pediatrics at the Baylor College of Medicine in Houston, Texas.
While it's possible for some kids to outgrow the excess weight, she warned parents not to count on that. "We've seen over time that the environment doesn't promote that," she said.
By Madison Park, CNN
Nearly one-fifth of American 4-year-olds are obese, and children of color are at higher risk, according to new research.
Obese children are at risk for early onset of diabetes, fatty liver and musculoskeletal problems.
Obese children are at risk for early onset of diabetes, fatty liver and musculoskeletal problems.
Researchers calculated the body mass index from a sample of 8,550 Hispanic, black, white, Asian and Native American 4-year-olds. The children were born in 2001, and in 2005, their height and weight were measured -- 18.4 percent of them were obese.
"Significant differences in the prevalence of obesity between racial/ethnic groups were evident at 4 years of age," the researchers wrote in the April issue of the Archives of Pediatrics and Adolescent Medicine.
Using body mass index, they found that 31.2 percent of American Indian/Native Alaskans, 22 percent of Hispanics, 20.8 percent of blacks, 15.9 percent of whites and 12.8 percent of Asians were obese.
"It's surprising that there are large differences by racial/ethnic group by that age," said Sarah Anderson, an assistant professor of epidemiology at The Ohio State University and lead study author.
Anderson and co-author Robert Whitaker's analysis showed that children were becoming obese even before encountering soda and candy vending machines in schools.
"These results really do point to the need for us to focus attention on early childhood and the need for research to understand how these differences can emerge so early," Anderson said. "To do that, we may need to understand the different family and cultural factors that are at play in these children's lives."
The cause for the early health disparities is hard to pinpoint, childhood obesity experts said.
"It's always possible there are biological factors within ethnic groups," said Dr. Tom Robinson, director of the Center for Healthy Weight at the Stanford University School of Medicine. "We know most of the changes that have occurred in body fat tend to occur from being in an environment that promotes very easy access to high-caloric foods and limited opportunities for physical activities."
Michael Rich, an associate professor of pediatrics at Harvard Medical School, called the disparities between ethnic groups disturbing.
"The expectations, lifestyle, behaviors are different on a cultural and socioeconomic basis," he said. "Kids who live in the inner city, whose neighborhoods are perceived as dangerous, stay at home more, sit more, eat more snacks, because that's all they can get at the local bodega. There are no supermarkets to get produce. That's what mom is eating, so that's what kid is eating. What we're dealing with here is whole life issues."
Previous research has shown that older children are becoming less active and spending more time in front of a computer or TV.
"That is displacing physical activity," said Dr. Sarah Barlow, director of the Obesity Center at Texas Children's Hospital in Houston. "You can imagine strollers, less outdoor play -- all those kinds of things that have shifted how much activity younger kids are getting. At the same time, portion sizes are increasing for everybody."
According to data from the Centers for Disease Control and Prevention, adults fare no better. Approximately 45 percent of blacks, 36.8 percent of Mexican Americans and 30 percent of whites are obese.
"It's a very bad sign if we see obesity at a young age," Robinson said. "When we see children obese at age 4, we're likely to see complications -- high blood pressure, abnormal lipids -- which can lead to heart disease and stroke, diabetes in children."
Diseases commonly seen in 40- or 50-year-olds are presenting in 6- and 7-year-olds. Obese children are developing type 2 diabetes, fatty liver disease and musculoskeletal problems, which occur because their bodies can't carry that much weight, doctors said. Calculate your child's body mass index.
"The heavier you are as a child, the likelier that extra weight will follow you through life," Robinson said. "That's why we see adolescents who need weight-loss surgery, because they have life-threatening complications from obesity."
If you have an obese child...
The first step is for the parents to acknowledge that the child is overweight, instead of making excuses or comparing him or her to heavier children. Many of the parents of obese children are overweight themselves, which makes that acknowledgment difficult, said Rich, who is also director of the Center on Media and Child Health at Children's Hospital in Boston.
"While it's important to focus on it and take it seriously, it's also important not to give up or feel hopeless," he said. "Then you won't try. You want to look at it for what it is and not be defeated by it."
When you're trying to help your child achieve a healthy weight, remove the stigma attached to obesity.
"It should always be about health, not about losing weight," Rich said. "You're trying to build the positive."
He recommended the 5-2-1-0 plan. Eat at least five servings of fruits and vegetables, cut screen time down to two hours or less, exercise at least one hour, and have zero soda and sugary drinks.
Such changes, which are not seismic shifts to lifestyles, can help the child get into a health weight.
"It's easier to start that way, rather than try to change habits when they're 8 or 12 or 16," said Barlow, an associate professor of pediatrics at the Baylor College of Medicine in Houston, Texas.
While it's possible for some kids to outgrow the excess weight, she warned parents not to count on that. "We've seen over time that the environment doesn't promote that," she said.
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