Tuesday, May 16, 2000

Report defines unequal mortality

Rates differ by race and geography

By Tim Bonfield
The Cincinnati Enquirer

        Even though more people in general are living into their 70s, 80s and 90s, heart disease and cancer are killing many black men in Hamilton County before they reach retirement age.

        Even though all cars have seat belts and most have air bags, young black men in Hamilton County are twice as likely as young white men to die in an accident.

        These are just two of many findings from a study of Ohio death data released this week by CORVA, a local health planning agency.

        Its “Health Status Disparities” study adds local numbers to a growing public understanding that the nation's leading causes of death do not strike with an even hand.

        Be it heart disease, cancer, or stroke, the rates of people affected by a particular cause of death vary widely from county to county. Even within a single county, diseases strike different groups of people at different rates.

        Defining these health gaps is a first step toward reducing them, said CORVA president James Sandmann. To that end, CORVA has assembled more than 150 pages of color-coded bar charts and maps breaking down Ohio's five leading causes of death according to age, race and gender between 1992-1996.

        “From our viewpoint, this study is monumental,” said Joseph Doodan, executive director of the Ohio Primary Care Association. “By knowing what groups, what gender, what ages are driving these rates, it makes it easier to set priorities for prevention efforts.”

        Among the findings:

        • Black people in Hamilton County, especially black men, tended to die at youn ger ages than white people in four of Ohio's five leading causes of death: heart disease, cancer, stroke, and accidents.

        • Chronic obstructive lung disease was the one leading cause of death that consistently occurred at higher rates among white people.

        • The sharpest differences in death rates often occurred in the 55-64 age group, when many people would consider death premature or preventable. Racial and gender gaps in death rates tended to even out in the 85 and over age group.

        • For AIDS, which was included in the study even though it is not among the six leading causes of death, mortality rates among black people largely mirrored statewide trends. However, the death rate among white men in Hamilton County was consistently higher than the state average.

Tracking health gaps
        To many people, it comes as no surprise that minority groups often suffer diseases at higher rates. But how big are the gaps? Why are the gaps occurring? Will extra efforts to reduce the gaps make any difference?

        Rather than making decisions based on political interests, misconceptions or outdated assumptions about how national health trends affect local communities, the health disparities study provides data, Mr. Sandmann said.

        CORVA plans to distribute its study to private foundations and state and local government agencies. In theory, groups will use the study to more accurately focus their services or to decide which proposal should get a grant.

        Eventually, CORVA hopes to track whether such efforts reduce the death rate gaps, Mr. Sandmann said.

        Some groups already have begun providing more culturally sensitive health educa tion messages.

        Last month, a group called the African-American Health Network named a new board of trustees as an early step in focusing more attention on health disparities.

        About two years ago, the Hamilton County chapter of the American Heart Association hired its first minority programming coordinator.

        Its “Search Your Heart” program provides training and equipment to black churches to conduct blood pressure screenings and stroke risk assessments.

        In its first year, the program reached about 60 of the estimated 200 Tristate churches with mostly or significantly black membership, said Candace Alexander, director of programs and education.

        Many factors appear to be contributing to higher heart disease and stroke deaths among black men in Hamilton County, Ms. Alexander said. Among them: higher rates of smoking, high blood pressure and diabetes (all major risks for heart disease); poor dietary habits; lack of education; and less access to health care (both linked to higher rates of poverty among blacks).

        “The whole issue of disparities exists not just for heart disease but many types of illness,” Ms. Alexander said. “African-American males are less likely to get routine health checkups, so you've got people walking around out there, then boom, they have a stroke and they never knew their blood pressure was high.”

        Ms. Alexander said many black people know they face higher health risks. Even so, information like the CORVA study helps bring the message home.

        “These are the kinds of things that change the way people think,” she said. “So they know it's not somebody else's disease.”


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