The Health Divide: Discrimination drives higher death rates in people of color, LGBTQ+ women

Cancer inequities narrow, but more work is needed

Women of color and women lacking health insurance experience “stark disparities” in breast cancer screening rates, reports Dr. Alisha Rathi for ABC News.

That’s one of the findings of the Cancer Disparities Progress Report 2024 from the American Association for Cancer Research (AARC), released last week.

The good news is that overall cancer deaths fell by one-third between 1991 and 2020, thanks to improvements in prevention, detection and treatment. But not all groups have seen equal benefit.  

As Rathi reports, women younger than 65 without health insurance were 50% less likely to be up to date on breast cancer screenings. Black women were 40% more likely to die of breast cancer than non-Hispanic white women.

Black and Indigenous people were less likely to have cancer, but more likely to die of it, compared to other demographics. In particular, Black people were twice as likely to die of multiple myeloma, and Black men were twice as likely to die of prostate cancer, compared to white people.

Among other demographics, the death rate from stomach cancer was twice as high in Hispanic, Asian, American Indian, Alaska Native and Pacific Islander populations compared to white people.

The AACR also notes a  recent JAMA report that found about a doubling of diagnoses of breast, colorectal, lung and prostate cancers in American Indian and Alaska Natives between 2004–2006 and 20017–2019. However, the AARC report described this finding as “encouraging” because it means data are being collected on this population.

Where people live also made a difference, with those in rural or non-metro areas 38% more likely to die of lung cancer than people in urban or metro regions.

Sexual and gender minorities were also impacted, with a higher risk of breast cancer among LGBTQ+ women than heterosexual women, and higher risk for lung and prostate cancer among transgender individuals.

The causes of these disparities are both genetic and social, the report said. Efforts to address the disparities include genetic studies targeting minority groups and programs to recruit underrepresented ethnicities to science and health careers to improve the quality of care for everyone.

On the positive side, the report found that disparities in cancer deaths have narrowed in recent decades. For example, the gap in cancer deaths between Black and white people dropped from 33% in 1990 to just over 11% in 2020.

Patient-focused care is an important part of the solution, Dr. Robert A. Winn, chair of the report committee, told ABC. 

The report calls for nearly $60 billion in federal funding for the National Institutes of Health, National Cancer Institute, and Centers for Disease Control and Prevention to fight inequities, reports Dennis Thompson at HealthDay.

“We must keep fighting to ensure equal access and improved health care delivery for all people,” Winn, who works at the Virginia Commonwealth University, said in an AACR press release. “The key is to keep talking, reporting, and advocating.”

Fallout from Maui fires affects residents of color

The 2023 wildfires that devastated Maui have had a disproportionate effect on the health of Latino, Native Hawaiian, Filipino and Pacific Islander residents, reports Brianna Sacks at The Washington Post.

Those are some of the results of the ongoing Maui Wildfire Exposure Study, which has assessed 679 residents impacted by the fires so far.

About one in ten Native Hawaiians and Pacific Islanders reported chest pain or raised heart rate.

Compounding those problems, “the fire crippled the island’s health-care infrastructure,” Sacks writes. Many groups are having difficulty accessing health care now.

Study participants had lower rates of health insurance than residents in the rest of Hawaii or the pre-fire population of West Maui. This problem particularly impacted Hispanic people, of whom almost four in 10 didn’t have health insurance after the fires.

Many affected residents prefer to get help from community organizations as opposed to government resources. Filipinos and other Asians were most likely to access help form community groups. Hispanic individuals were least likely to get help from either government or community resources.

Almost half of the study participants had low food security, with more than 60% of Filipinos, Hispanics and Latinos reporting low or very low food security.

“There is no light at the end of the tunnel at this point because the tunnel is so far ahead,” Maria Linz, a burn zone resident and coordinator with the Kako‘o Leiali’I Recovery Center, told The Post. “We can’t even see the beginning of the tunnel at this point.”

Disabled people lose services during Medicaid unwinding

Advocates say the spring 2023 end of pandemic-era protection for Medicaid recipients, which allowed states to again take ineligible people off the rolls, has been biased against those with disabilities, reports Daniel Chang for KFF Health News. 

Individuals who rely on home health aides can suffer when those services are suddenly — and often mistakenly — taken away. Because there’s a shortage of home care workers, they may not be able to quickly restart services with the same or new providers once any insurance issues are ironed out.

U.S. laws requires states to ensure people with disabilities have their needs met, but that has not happened during the Medicaid “unwinding,” said Elizabeth Edwards, senior attorney with the nonprofit National Health Law Program. For example, deaf and blind people require adaptations for communication. States could have set up telephone lines devoted to disabled Medicaid enrollees, but some states did not do so, Edwards said.

The National Health Law Program has filed civil rights complaints in Colorado, Texas, and Washington, D.C., and has also reported cases of discrimination against people with disabilities in Florida.

Many with disabilities said they didn’t receive the notices about Medicaid disenrollment that states claimed to send. And a 2023 audit found that 90% of notices sent in Colorado contained errors, such as incorrect dates.

Chang also reports that some states did not incorporate special rules for home health service eligibility into the unwinding process, leading eligible people to see their services dropped.

And in some cases, Medicaid recipients were told they had to reapply for coverage, instead of appealing a cancellation. Services are continued during an appeal but cut off if a person re-applies, said Miriam Harmatz, an attorney and founder of the Florida Health Justice Project.

Lesbian, bisexual women die earlier of preventable causes

Lesbian and bisexual women die earlier than their straight counterparts, reports Elaina Patton at NBC News. 

That’s the conclusion of a study in JAMA, based on data from more than 90,000 participants in the long-running Nurses’ Health Study II, which began in 1989.

Lesbian women died 20% sooner than heterosexual women and bisexual women died 37% sooner.

The team expected to see differences in death rates, because lesbian, gay and bisexual woman are subject to disparities in health factors such as tobacco and alcohol use, chronic disease, and mental health, lead author Sarah McKetta of Harvard Medical School told NBC. But the gaps in death rates were much starker than anticipated.

“This isn’t something that just happened,” said McKetta. “It’s due to levels of discrimination, ranging from structural to individual.”

McKetta hopes the study will draw attention to the discrimination in settings such as medical clinics and workplaces that drive poor mental and physical health.

“It doesn’t kill to be gay,” she said. “It kills to be discriminated against.”

From the Center for Health Journalism

• May 21 Webinar, 11 a.m. PT: “How can health care do better for LGBTQ+ patients?” We’ll cover key data. Points, discuss forward-thinking approaches to combatting discrimination, and learn how journalists can tell stories on these issues with nuance and thoughtfulness. Sign-up here!
• May 23 deadline to apply for Domestic Violence Impact Reporting Fund. The Fund provides reporters with a roadmap for covering this public health epidemic with nuance and sensitivity, reporting grants of $2,000–$10,000, and five months of professional mentorship from a veteran journalist. Learn more here!

What we’re reading

• “Tribal nations invest opioid settlement funds in traditional healing to treat addiction,” by Aneri Pattani and Jazmin Orozco Rodriguez, KFF Health News
• “Rising child mortality rate hits Black children harder,” by Jennifer Porter Gore, Word in Black
• “Feds accuse Rhode Island of warehousing kids with mental health, developmental disabilities,” by Steve LeBlanc, AP News
• “There’s a renewed push in Congress for Medicaid to cover doulas and midwives,” by Darreonna Davis, The 19th
•  “Five facts about Black women’s experiences in health care,” by Shannon Schumacher, Latoya Hill, Samantha Artiga, Liz Hamel, and Isabelle Valdes, KFF