Racial Disparities in Health Care

A recent New York Times article written by Roni Caryn Rabin discusses Dr. Marcella Nunez-Smith’s goals of addressing racial gaps in health care. Dr. Nunez-Smith is a practicing internist and scientist. She directs several research centers and acts as an associate professor of internal medicine, public health management at Yale University. She has been appointed by President-elect Joseph R. Biden Jr. to lead a new federal task force, an act introduced by Senator and Vice President-elect Kamala Harris aimed to combat racial and ethnic disparities in our nation’s COVID-19 response.

Dr. Nunez-Smith grew up in the United States Virgin Islands, where she saw the harmful repercussions that limited health care has on a community. Racial health disparities, fueled by underlying social and economic inequalities, have been made even more distinct by the pandemic.

The Centers for Disease Control and Prevention data indicates that Black, Latino, and Native Americans are infected with COVID-19 and/or hospitalized at disproportionately higher rates than white Americans. Additionally, the death rate of these groups is nearly three times higher. Dr. Nunez-Smith emphasizes:

We cannot overstate the disproportionate impact.”

There are many contributing factors for these numbers including living in crowded households, the ability to work from home, and underlying health problems due to limited access to medical care, that increase the risk of severe COVID-19. Dr. Nunez-Smith states:

What’s needed to ensure equity in the recovery is not limited to health and health care. We have to have conversations about housing stability and food security and educational equity, and pathways to economic opportunities and promise. There are people whose jobs require them to leave their homes, and if we don’t have a message to them, that’s our failure.”

JAMA Network Open recently published a study that found Black patients were more likely to test positive for COVID-19 than White patients. However, they had a lower mortality rate after hospitalization. Researchers suggest that neighborhood characteristics may explain the disproportionately high out-of-hospital COVID-19 mortality rates among Black individuals. They explain:

This may be because of pervasive social inequalities that increase the difficulty in implementing social distancing in Black and Hispanic communities. Black and Hispanic patients are associated with a lower neighborhood SES and are more likely to work in occupations that are not amenable to working remotely compared with White patients.”

These findings support the notion that Black and Hispanic populations are not inherently more susceptible to having poor COVID-19 outcomes than other groups. Existing structural determinants including housing inequality, access to care, employment, and poverty that are more pervasive in Black and Hispanic communities are likely causes of COVID-19 ethnic disparities. Dr. Gbenga Ogedegbe, the director of the division of health and behavior at New York University’s Grossman school of Medicine reviewed these findings and states:

We hear this all the time — ‘Blacks are more susceptible.’ It is all about the exposure. It is all about where people live. It has nothing to do with genes.”

Another article published in JAMA Network Open presents a data analysis which demonstrates the inequitable allocation of COVID-19 testing relative to the disease burden between Black and White communities in St. Louis, MO. They suggest that testing needs to be increased relative to the disease burden in order to ensure that not just the most symptomatic cases are identified in an area. Researchers opine the reasons for undertesting in certain communities are likely existing disparities in the health care infrastructure, access to health care, and mistrust of the health care system, which all stem from structural racism within the system itself.

Dr. Clyde W. Yancy, chief of cardiology at Northwestern University Feinberg School of Medicine speaks on Dr. Nunez-Smith’s plan to combat the racial disparities in COVID-19 response in the United States. He states:

Yes, it will be hard, and we will need to take iterative steps, but begin is exactly what we should do, and considering the link between poor health, poor education, poor housing and poverty, a case can be made to target economic development in the most vulnerable communities as an important first step.”

Racial gaps in the United States health care system are prevalent and precipitate the disparity of the COVID-19 response. The new federal task force aims to address the underlying structural issues within the system to promote health care equity among all racial, ethnic, and socioeconomic groups. The attorneys at Abramson, Brown & Dugan believe everyone is entitled to adequate health care. If you or someone you know has been harmed as a result of medical malpractice, contact us today

Colorectal Cancer Screening

A recent proposal by the U.S. Preventative Services Task Force recommends that adults should start screening for colorectal cancer routinely at age 45, instead of waiting until age 50.  The task force is an independent group of experts appointed by the Department of Health and Human Services. While it still must be finalized, its guidance on screening and preventative care services reflects a rise in higher rates of colon and rectal cancer in generations born since 1950, The New York Times states. According to a study by the American Cancer Society, 12% of the 147,950 colorectal cancers that will be diagnosed this year will be found in adults under the age of 50; that is over 18,000 cases.

A group disproportionately affected is African Americans, who are 20% more likely to get colorectal cancer, and 40% more likely to die from it that most other groups. This is due to a combination of complex reasons, including risk factors, health care access, and socioeconomic status.

An article published in JAMA Network examined the incidence rates of colorectal cancer in 1 year increments, focusing on the transition between ages 49 and 50 years of age. Researchers studied 165,160 patients from a variety of demographic backgrounds and geographical regions from 2000-2005. They observed the colorectal cancer incidence rates in 1-year age increments (30-60 years) in the Surveillance, Epidemiology, and End Results 18 registries (STEER 18). They found an incidence rate increase of 46.1% from 49 to 50 years of age. A total of 92.9% of the cases of colorectal cancer diagnosed at 50 years of age were invasive (beyond situ stage).

The steep incidence increases from 49 to 50 years of age are consistent with preexisting colorectal cancers diagnosed via screening uptake. These findings suggest the presence of a large undetected preclinical case burden in patients younger than 50 years old that is not observed in the STEER 18.

These results support the recommendation to begin screenings earlier. The panel also emphasized that health care providers should especially encourage black men and women to be screened at 45 due to high rates of disease and higher death rates in the African American community.  Dr. Kimmi Ng, director of the Young-Onset Colorectal Cancer Center at the Dana-Farber Institute in Boston comments “Lives will be saved. We will be preventing cancers in young people, catching them at an earlier stage when they are more likely to be curable, and hopefully improving survival rates.”

While some physicians are vigilant, some younger patients feel their complaints are dismissed by doctors. The Colorectal Cancer Alliance states 81% of young adults with colorectal cancer said they experienced at least three symptoms of cancer before getting diagnosed. Additionally, more than half were misdiagnosed with hemorrhoids, anemia, IBS, or mental health problems. Abramson, Brown & Dugan is committed to advocating on behalf of people who have not received adequate preventative care, diagnosis, or treatment by health care professionals. If you or someone you know has been affected by malpractice, contact us today.

Epidurals and Autism

A recent study published in JAMA Pediatrics examines the association between epidural analgesia during labor and the risk of autism spectrum disorders (ASD) in offspring. Researchers looked at a multiethnic population-based clinical birth cohort of 147,895 children who were delivered vaginally between 1/1/2008 and 12/31/2015. Children were followed up to the age of 1 year or until: clinical diagnosis of ASD, last date of health plan enrollment, death, or the end of the study. Autism spectrum disorders were diagnosed in 1.9% of the children delivered using epidural analgesia versus 1.3% of the children delivered vaginally without it. After adjusting for potential cofounders, this is a 37% relative increase in risk which is significant. The results of this study suggest that maternal labor epidural analgesia (LEA) may be associated with increased risk for children developing ASD.

While further research is warranted to confirm the study findings, the potential implications are significant. Epidural analgesia is a central neve block technique achieved by injecting a local anesthetic close to the nerves that transmit pain. This is done so through a catheter in the lower back that continuously delivers medication throughout labor. Epidurals are a widely accepted practice used to ease the pain of childbirth for women. An article published in Stanford Medicine examined 17 million deliveries nationwide from 2009-2014, which found that epidurals or other spinal anesthesia were used in 71% of births, a 10% increase from 2008.

The growing numbers of epidural analgesia during birth is concerning given the findings of Chunyuan Qiu, MD, MS, Jane C. Lin, MS, and Jiaxiao M. Shi, PhD in JAMA Pediatrics. While there are many suspected links, there is no known single cause for autism spectrum disorder. If epidurals do indeed increase the risk of a child developing ASD, it would impact many women’s decision regarding pain management during childbirth. Abramson, Brown & Dugan specialize in medical malpractice law and have extensive experience in birth injury related cases. If you or someone you know has been affected by medical malpractice, contact us today.

Blood Testing for Brain Damage

A recent article published in Imperial College London News discusses the ongoing research and development of a blood test prototype for brain damage in newborns who experienced oxygen deprivation during birth. Imperial College London, in collaboration with groups in India, Italy, and America conducted their research in Indian hospitals and published the findings in Scientific Reports.

Oxygen deprivation can occur for a variety of reasons including a lack of oxygen in the mother’s blood, infection, umbilical cord issues, birth canal delays, placental separation, and delivery trauma. Oxygen deprivation can lead to brain damage, which develops over hours to months after birth. Depending on what part of the brain is affected, this can result in a number of different neurological including cerebral palsy, erb’s palsy, epilepsy, and others.

The researchers conducted their preliminary study using 45 babies that experienced oxygen deprivation at birth. The babies had their blood taken within six hours of birth, and then again 18 months later. It was sequenced to examine any differences in gene expression between the babies who had developed neurodisabilities and those who did not.

In total, researches found 855 genes that were expressed differently between the two groups, two of which were significantly different. Lead author Dr. Paolo Montaldo hopes that examining these two genes could help scientists better understand the causes of neurodisabilities following oxygen deprivation and subsequently, how to disrupt them. Identifying babies most at risk for developing a neurological condition would also allow for targeted early interventions for improved outcomes. The team of researchers plans to expand their blood testing study to a larger number of babies to gather more insight.

The potential benefits of early diagnosis are endless. However, even with a confirmed diagnosis and early intervention, the effects of brain damage due to oxygen deprivation can cause serious lifelong neurological, developmental, physical, behavioral, and psychological issues. The attorneys at Abramson, Brown & Dugan are committed to helping those who have been negatively impacted by physician error. All of our attorneys are experienced in the field of medical malpractice; Kevin Dugan has a particular concentration in birth injury cases, including medical errors in labor and delivery resulting in newborn brain injury and cerebral palsy. If you are seeking support or would like to discuss a potential case, contact us today.

 

Cardiovascular Disease in Women

An article written by Shiva R. Mishra, MPH, Hsin Chung, PhD, and Michael Waller, PhD published in JAMA Network discusses the association between reproductive life span and the incident of nonfatal cardiovascular disease (CVD) in women. CVD is a group of diseases involving the heart or blood vessels, which includes hypertension, coronary artery disease, heart attacks, heart failure, heart valve problems, and abnormal heart rhythms. Early menarche and early menopause are known risk factors for CVD in women. Researchers looked at 12 studies, analyzing a total of 307,855 women in the International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events (InterLACE) to investigate the correlation between reproductive life span in addition to the age at menarche and menopause.

From the women surveyed, the mean age at menarche was 13, the mean reproductive life span was 37.2, and the mean age at menopause was 50.2. They found that women with very short (<30) reproductive life spans were at 1.71 times higher risk of incident CVD events than women with reproductive life spans of 36-38 years. Women who had had both short reproductive life spans (<33) and early menarche (age <11 years) had the highest risk of CVD compared with the median menarche age and reproductive life span length.

A study lead by Saraschandra Vallabhojosyula published in Circulation: Heart Failure looked at sex disparities in the management and outcomes acute myocardial infarction-cardiogenic shock (AMI-CS) in the young. A total of 90,648 AMI-CS admissions between the ages of 18 and 55, during 2000 to 2017 were reviewed; 26% of which were women. They found that in young AMI-CS admissions, women were treated less aggressively. Women received less frequent coronary angiography than men (73% versus 78.7%), less early coronary angiography (49.2% versus 54.1%) less percutaneous coronary intervention (59.2% versus 64%), and less mechanical circulatory support (50.3% versus 59.2%). Subsequently, female sex was an independent predictor of in-hospital mortality (23% in women versus 21.7% in men).

The presentation of CVD looks different in men and women; despite the impact of CVD on women, awareness and education remain low. Assistant Professor of Medicine at Johns Hopkins School of Medicine Lili Barouch, MD explains “Women are much more likely to have atypical heart attack symptoms. While the classical symptoms, such as chest pains, apply to both men and women, women are much more likely to get less common symptoms such as indigestion, shortness of breath, and back pain, sometimes even in the absence of obvious chest discomfort”

Hanna Gaggin, MD, MPH and Andrew Oseran, MD, MBA wrote an article for Harvard Health Publishing regarding the gender differences in cardiovascular disease. A recent study based on over two million patients found that women were less likely to be prescribed aspirin, statins, and certain blood pressure medications compared to men. These types of medications are commonly used to prevent CVD or its progression. A general lack of awareness of CVD in women may lead to doctors missing heart attacks in women or delaying their diagnosis.

Regardless of your sex, it is your doctor’s responsibility to provide adequate prevention, diagnosis, and treatment to protect your cardiovascular health. Abramson, Brown & Dugan is committed to advocating for people who have been negatively impacted by medical malpractice. If you or someone you know has been harmed due to medical error, contact us today.

Time Change and Medical Errors

A recent article published in The New York Times discusses a study in the Journal of General Internal Medicine which examines the link between time change and medical errors. The study’s lead author Dr. Bhanu Prakash Kolla is a professor of psychiatry at the Mayo Clinic in Rochester, MN. Researchers utilized voluntarily reported, patient safety-related incidents caused by defective systems, equipment failure, or human error. They looked at data from the seven days preceding and following time changes in the spring and fall over an 8-year period. There were no significant differences in overall errors. However, when the researchers looked at the number of human errors alone, there was a statistically significant increase of 18.7%, mostly involving medication administration. This increase was only observed during the fall time change, when the clocks were moved backwards by one hour.

Time Magazine published a piece outlining the origin of daylight saving time, the principal purpose of which is to save energy. Its effectiveness in doing so is unclear; numerous studies have been conducted with conflicting findings. CNN published a story examining the effects changing the clocks has on our sleep. Dr. Kannan Ramar, a sleep specialist at the Mayo Clinic states, “We’ve had evidence slowly building up over the years, in terms of the adverse effects when we move from daylight saving time to standard time, and vice versa.” These impacts include cardiovascular issues like stroke and atrial fibrillation, medication errors, mental health struggles, and increased traffic accidents. This aligns with Dr. Kolla’s results that indicate when we lose an hour of sleep in the fall, human error, specifically involving medication administration, increases significantly.

Dr. Rafael Pelayo, a sleep specialist with the Stanford Sleep Medicine Center states “Biologically it doesn’t make any sense. Even though you’re just getting an hour less of sleep, it takes about five days to get back in sync.” The American Academy of Sleep Medicine (AASM) agrees, calling for a permanent, countrywide transition to a single system of time. Some legislatures agree too; ‘The Sunshine Protection Act’ was introduced in 2019 and proposes observing daylight savings time permanently. So far there are currently 13 states that have enacted legislation and at least 32 states that have considered 85 pieces of legislation to provide for year-round daylight saving time. Current federal law requires an act of Congress to make the change. While the future of daylight-saving time is uncertain, the research suggests that losing an hour of sleep in the fall can significantly increase the occurrence of human error and subsequent medical malpractice.

Regardless of the underlying reason for the malpractice, physicians must be held accountable for their medical errors. The attorneys at Abramson, Brown & Dugan have vast experience handling medical malpractice cases. If you or a loved one has been harmed as a result of medical error, contact one of our experienced attorneys today.