A raft of research suggests that socioeconomic factors such as disparities in income and education are responsible for a sharp division in health outcomes for blacks and Hispanics on one end and whites on the…
A raft of research suggests that socioeconomic factors such as disparities in income and education are responsible for a sharp division in health outcomes for blacks and Hispanics on one end and whites on the other.
Overall, blacks and Hispanics are more likely to suffer from chronic conditions like heart disease and obesity than whites. Black and Latina expectant mothers have a higher infant mortality rate than non-Hispanic whites; the infant mortality rate for black women is more than double the rate for whites.
Most of this research focuses on adults, but a new study suggests that gaps in health outcomes between blacks and Hispanics and whites applies to kids, too. Black and Hispanic kids are more likely to die of some childhood cancers than white children, according to a study published in August in the journal Cancer. The disparity in outcomes is largely attributable to difference in socioeconomic status — the measure of a person’s standing in society (what researchers call “SES”), measuring factors like income, education and occupation, the study suggests. The findings are based on an analysis of a database of 31,866 cases of childhood cancer diagnosed between 2000 and 2011.
The study confirmed that race is a factor when it comes to cancer survival. Compared to white children, black kids were between 38 and 95 percent more likely to die of nine cancers studied. Among the six cancers in which there was a significant disparity in survival between white and Latino children, Hispanic kids were between 31 and 65 percent at greater risk of mortality. Much of the difference in survival rates was attributable to differences in socioeconomic status. For example, 44 percent of the difference in the survival rate between whites and blacks for acute lymphoblastic leukemia was attributable to socioeconomic status, researchers found. Similar differences in survival rates were found between Hispanics and whites. For instance, white kids have a better survival rate than Hispanic children for acute myeloid leukemia, and 73 percent of the difference is attributable to the disparity in the two groups’ SES, the study suggests. “Our findings point to the need for continued research that is focused on understanding and, ultimately, addressing racial and ethnic disparities in childhood cancer survival,” says Rebecca Kehm, an epidemiologist and the leader of the study. She’s a postdoctoral researcher at Columbia University. “We as a research community need to devote more resources and attention to the social determinants of health. We need to prioritize research that is focused on understanding how social factors, such as access to high-quality health care and health literacy, contribute to health and health disparities.”
The new research highlights how differences in economic and educational opportunities lead to worse health outcomes for blacks and Hispanics in the U.S. compared to whites, says Eric Feigl-Ding, an epidemiologist and visiting scientist at the Harvard Chan School of Public Health. He focuses on the intersection of epidemiology, nutrition, health economics and public policy. “Poverty leads to a cascade of effects that result in poor health outcomes,” he says.
Feigl-Ding provided an example: A single black or Hispanic mother works one or two jobs that pay by the hour. Neither of her parents went to college and she didn’t, either, so the only work she could get pays hourly. Neither of her employers provides health insurance, so she doesn’t take her children to a doctor for an annual physical because of the doubled cost: the expense of paying for the visit, and the wages she’d lose taking time off work. Consequently, when her kid’s illness is diagnosed, “it’s a much more severe, high-grade cancer,” he says. Furthermore, without health insurance, the mom can’t afford to pay for medical treatment or prescription medications for her ill child.
Detecting a serious illness like cancer later, rather than sooner, can have dire consequences, says Dr. Michael Scheurer, a molecular epidemiologist and director of the Childhood Cancer Epidemiology and Prevention Center of the Texas Children’s Cancer Center. “We know that delayed diagnosis can contribute to worse outcomes and that children who live in poorer neighborhoods are less likely to be diagnosed early,” Scheurer says. “Also, children from lower socioeconomic backgrounds are less likely to completely follow treatment regimens due to a variety of factors. However, we also are starting to recognize that there are biological differences in the tumors that arise in black and Latino children compared to whites. So there is more than just the social and health care system issues at play.” Further study on those biological differences is needed, Scheurer says.
Environmental issues tied to socioeconomic status can also affect the health outcomes of black and Latino children, says Karen M. Dale, market president for AmeriHealth Caritas District of Columbia. For example, research suggests that, whether they live in cities or in rural areas, African-Americans and Hispanics are more likely than whites to live in areas where they have higher levels of exposure to the pollutant nitrogen dioxide, which is produced by industrial activity, construction and motor vehicles. Research has linked nitrogen dioxide to increased risks of heart attack and asthma. “The families that find themselves with exposure [to environmental hazards] are more likely to have a child who becomes ill,” Dale says.
Where people live — which is also greatly influenced by socioeconomic status — can also affect not only their health but their expected lifespan. In some areas, there are stark differences in the life expectancy of people who live just a few miles apart. For instance, in the District of Columbia, people who live in the Barry Farm neighborhood in the Southeast section of the city, which is virtually all black and poor, have a life expectancy of 63.2 years, according to figures from the Centers for Disease Control and Prevention; just 10 miles away, a child born in the upscale, largely white neighborhoods of Friendship Heights and Friendship Village can expect to live about 33 years longer, to age 96.1 years.
Living in poverty or in a distressed neighborhood can also make it difficult for parents to follow through on a child’s treatment regimen, says David B. Miller, an associate professor at the Jack, Joseph and Morton Mandel School of Applied Social Sciences at Case Western Reserve University in Cleveland. “Think of a family with a child diagnosed with cancer that has no health insurance and lives in a state without Medicaid expansion,” he says. “These circumstances can affect their ability to adhere to a treatment regimen. If the parent doesn’t have a car, is there public transportation to take the child to medical appointments? Can the parent take time off from a minimum wage [or slightly higher-paying] job? How will the family pay for prescription drugs? Will paying for that medication mean other household expenses go by the wayside?”
The problem of disparate health outcomes attributable to socioeconomic differences won’t be solved any time soon. However, there are some steps parents who are struggling economically and who live in a distressed neighborhood can take to try to safeguard the health of their children.
Making sure each child gets an annual physical is crucial, Dale says. Health care providers can notice changes in a youngster’s health that could lead to early detection of cancer and other serious illnesses. An early diagnosis could make the difference between a child surviving and dying, she says. Parents who don’t have good health insurance or any coverage at all can take their child to a community health center that serves low-income people on a sliding scale or for free. These federally funded centers are the primary health care providers for more than 27 million people in 10,400 urban and rural communities nationwide, according to the National Association of Community Health Centers. Health care professionals at these clinics can identify potential cancer symptoms, like a persistent cough in a patient who has no history of asthma, and make referrals to specialists for follow-up tests.
Taking your child to the dentist twice a year is another good strategy, Dale says. A dentist can detect problems — like bleeding gums — that could indicate a serious non-dental medical problem, and then make a referral to a specialist for tests, she says. Some community health centers have dentists. Dental schools that offer low-cost or free care by dental students are another option.
Once a child is diagnosed, parents should, if possible, try to get him or her treated at a large medical institution that specializes in treating pediatric cancer, says Dr. Karen M. Winkfield, a radiation oncologist and director of Wake Forest Baptist Health’s Office of Cancer Health Equity in Winston-Salem, North Carolina. “Since pediatric cancer is rare, going to an institution that specializes in caring for children with cancer will ensure access to the latest therapies and may provide the best support and resources for families, because the medical personnel there will have a lot of experience treating it,” she says.
Poor adherence to a medication regimen makes the treatment of a child with cancer much more difficult, says Dr. Jeffrey D. Hord, Director of Pediatric Hematology-Oncology at Akron Children’s Hospital in Akron, Ohio. Parents within a lower socioeconomic status may not have the option of taking weeks or months off to help their ill child become accustomed to a complicated chemotherapy regimen and to directly supervise their child when taking oral medications. Writing down detailed directions about the treatment plan can be useful, Hord says. Texting or emailing reminders can also be helpful.
Parents with financial concerns should also ask health care providers about resources for families who have a a child who is being treated for cancer, says Philip J. Lupo, a molecular epidemiologist at Texas Children’s Cancer Center and associate professor of pediatrics at Baylor College of Medicine in Houston. For example, Ronald McDonald House Charities provides an array of services, including lodging, at little to no cost to families who have to travel to obtain medical treatment for a child diagnosed with cancer. “Many of those who treat children with cancer are aware of both local and national resources for families,” Lupo says.